This case involves a fifty-four-year-old female patient who underwent a vaginal vault repair. She subsequently had damage to her sciatic nerve suffering from motor/sensory dysfunction with paralysis postoperatively. Additionally, she had pain and numbness in her left foot and hip. As a result, she had a second procedure in an attempt to repair the damaged sciatic nerve. It was discovered the suture anchoring the left uterine ligament transected the sciatic nerve. Unfortunately, the above symptoms continued and she walks with a limp. She also suffers from complex regional pain syndrome controlled with narcotics.
Question(s) For Expert Witness
- 1. What is the likelihood of sciatic nerve damage in vaginal vault repair?
Expert Witness Response
Pain, temporary urinary retention, and constipation are common in the perioperative period. Serious complications are uncommon, and include development of a hematoma, infection, inclusion cyst formation, fecal impaction, and injury to the rectum with the development of a rectovaginal or a rectoperineal fistula. Bowel and defecatory dysfunction may continue long-term, and prolapse may recur de novo dyspareunia or fecal incontinence may also occur. Utilization of mesh is associated with additional complications, such as mesh erosion, infection of the graft, and persistence of granulation tissue. Sciatic nerve transection is an extremely uncommon complication of vaginal vault repair and likely due to an inexperienced surgeon.