This case involves a sixty-two-year-old woman who presented to her women’s health clinic complaining of severe postmenopausal bleeding along with pelvic organ prolapse. The patient underwent several rounds of diagnostic testing and her physician suggested that her issue would be best resolved with a total abdominal hysterectomy. The patient underwent an open hysterectomy procedure that was repaired with a mesh product, but shortly after the initial procedure, several complications ensued. The patient was identified to have a bowel perforation from an invasion of the mesh product into the abdominal tissue. The implant invasion and bowel perforation led to a fulminant infection, sepsis, and shock. The long-term, hypotensive episodes led to chronic kidney failure and the need for lifelong peritoneal dialysis.
Question(s) For Expert Witness
- 1. What is the standard of care in treating pelvic organ prolapse after a total abdominal hysterectomy?
Expert Witness Response E-000554
The recommended management strategy for severe symptomatic pelvic organ prolapse for patients who failed or refused a trial of pessary management is surgery. A variety of surgical approaches are available to correct pelvic organ prolapse. Despite the widespread use of polypropylene mesh for transabdominal correction of apical vaginal prolapse, the use of grafts for transvaginal prolapse repair has been controversial. Few prospective randomized controlled trials have been published on the use of grafts in transvaginal anterior vaginal prolapse repair. Additionally, few human studies exist comparing various grafts and techniques.