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Mesh Erosion/Bowel Involvement? Mesh Erosion/Bowel Involvement?

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Unread 03-29-2006, 11:15 AM
Mesh Erosion/Bowel Involvement?

Hello again Ladies -- I'm back with more questions. I am a 47 y/o. I had TAH/BSO, paravaginal retropubic susp done 12/01 and 6 wks later Vag Vault Prolapse. Three and 1/2 mths later, in April of 02, I finally had the reconstructive surgery which consisted of Abd Sacro w/Mersilene Mesh, Vag Cuff Revision and Abd Enterocele Repair. I have done fine other than worsening LLQ pain for nearly 4 years. In Aug of this year, just before Katrina hit our area, I noticed a discharge w/some bleeding. This got noticeable worse during the aftermath of the storm but I was finally able to get to ob-gyb. He treated me for Garnerella. A week later, I still had the infections so he called in more antibiotics. It didn't help so I went to my sisters dr who treated me for the same thing. Well, of course, that didn't help either. Then, what do you know, a rectocele occurred. I went back to gyn and told him that I needed further testing. That I was really concerned in light of the fact that I've had carcinoma removed that was in-situ. So, he did a thorough exam and discovered what was either a stitch or mesh and inflammation. He sent me to an onco. This dr did an extremely thorough exam, told me I had mesh erosion and also a problem w/my sling. He wanted to know who did the recon. surgery? I was so upset by this time, I couldn't recall my own name, much less the surgeons. He called in a uro/gyno who affirmed the diagnosis, and he too wanted to know who did this? i was able to tell him the name. After dressing, me and hubby met with the onco in conference room and, turns out it wasn't as bad as originally suspected and the uro/gyno happens to know the surgeon and he's a good surgeon and why don't I go see him? After all, he's the one who knows what he did. So, I did. After a brief exam, he acknowledged the recto and the mesh erosion in vag. No mention of sling problem. What he wanted to know, was if I was still smoking. That was his ticket. Anyway, during the ensuing discussion, it was decided that we would treat the infection. If successful, we would go in vaginally and do the recto repair and snip and stitch the erosion. However, if this wasn't successful, and I have no reason to think it will be, (This is my 11th round of antibiotics and none have helped) that he would do abd exploratory surgery and attempt to cut out the mesh. He is terrible concerned about bowel involvement though. He said that after this amount of time, he's quite certain there will be massive scar tissue and that while he's chipping away at it, he might inadvertantly cause damage to my colon which would result in a colostomy. I asked if this wouldn't be temporary and he said, and I quote, "probably not" I went home and talked to my gyn who was shocked when I said the 'for life' bit. He said the surg was probably just giving me a worse case scenario but that is not the picture I got at all. I called the surg office back to schedule a phone consult with a list of questions I have and have not been able to speak with him. His nurse got my chart out tho and attempted to answer some of them. From the moment I asked my first question, she started on the smoking issues. I listened patiently and interrupted her and said, "ma'am, with all due respect, I know I need to quit smoking for more than one reason but I also know of other women (thnx to this website) who've had these same types of problems and never smoked a day in their lives so could we just get on with the answers to the questions I have without the lecture?" Anyway, she says that the reason the dr is so concerned about bowel involvement is because the mesh is sewn around my bowel.....Is this normal? Also, I found out that he has only had this erosion thing come up 3 times and she didn't know if he'd ever had to go in abd to remove it. So, a new surgeon if definitely in order. I just don't know where to go. If anyone can suggest a university or medical ctr that specializes in these 'special needs' areas, I would sure appreciate a private mssg or e-mail. So, is smoking a real factor with mesh erosion? Is it common practice to have the mesh attached to or around the colon? Anyone?

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Unread 03-30-2006, 12:30 PM
Mesh Erosion/Bowel Involvement?

I assume the "sling" you are referring to is the mesh that was used to suspend the vaginal vault during the sacral colpopexy. (You said you had a retropublic bladder suspension and paravaginal repair, which are not generally thought of as "slings.")

If you ever have looked at the pictures on websites which show this surgery, you can see why they would be concerned about the mesh and your bowel being engaged. In fact, I am sure that injury to bowel would have been one of the complications of the original surgery. Your surgeon may not have dwelt on it, or you may have passed over it. (They have to list EVERYTHING on those darned consent forms and from them you can never tell whether something is a common occurrence or a one-in-a-million chance.)

Having had a temporary colostomy for seven weeks after my hysterectomy (asymptomatic and therefore undiagnosed endometriosis had my uterus and rectum/colon adhered together; puncture occurred during attempt at vaginal hyst.), I can only imagine how difficult it is for you to make the decision about whether to have this surgery that could result in a permanent colostomy.

A second opinion never hurts.

As to the smoking, I don't know whether it is implicated in mesh erosions or not. Maybe someone else on this board has the info on that. You could do a google search on "mesh erosion" and "smoking" and see what turns up.

Best wishes to you. My prayers are with you.
Unread 03-30-2006, 10:32 PM
Mesh Erosion/Bowel Involvement?

Bonniebes - hi and yes i was referring to the sacral colpopexy...but since i posted this mssg i've received my medical records from the dr who did the reconstructive surgery and there's a very good reason he's concerned about bowel involvement....while doing a Halban's culdoplasty/enterocele repair, he actually sewed stitches into the surface of my colon....and attached these sutures to the mesh.
This is in his surgical report....I have talked to my gyn and he consulted another dr and they can't seem to come up with any reason why the surgeon would do this....i have been researching the procedure and everything i read says not to do this or that in order to avoid problems with the bowel or colon. I have attempted to call the dr or the nurse several times and they don't return my calls...probably because I was asking specific questions about 'bowel involvement' the last time we spoke. I have an appt with them towards the end of april and will have my list of questions with the meantime, if you know where i can find specifics on the Halban culdoplasty procedure, i'd appreciate it. everything i read is pretty vague.
and yes, i'm trying to find a competent with a bit more experience in this area....i can't imagine 7 wks much less a lifetime with a colostomy. my heart goes out to you....i assume you've recuperated and are now ambulatory and fully functional? I think if he'd said a temporary thing....well, i wouldn't like it but it wouldn't scare me as bad, you know? i told my gyn that if that's the best he thinks he can do, then i appreciate his honesty but i wasn't willing to settle for should have heard him when i said colostomy for life....FOR LIFE!!!! he thinks the dr must have been giving me the worst case scenario but i told him i didn't think so....and now that i've read the report, well, i know there's plenty of reason for concern...i just don't know who is out there that might can help me now....please keep praying for me....i believe in the power of prayer....seems like i never stop lately.
thank you,
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Unread 03-31-2006, 12:24 PM
Mesh Erosion/Bowel Involvement?

Wow I don't blame you for not wanting to have that doctor touch you again. I have had that same thing said to me - about the permanent colostomy, I hope it was just my gyn's way of getting out of surgery. For some reason he said that when scar tissue forms around your sphincter and rectum area, it becomes like cement and if you chip away the wrong area, they would have to perform a colostomy - ugh. I'm not giving up either and in fact am starting testing in the next couple of months to see if I can possibly get my rectocele repaired - having to live like this forever is not a good thought either. Good Luck to you. Hugs.
Unread 03-31-2006, 10:31 PM
Mesh Erosion/Bowel Involvement?

hey bowling-- my gyn said i could go on and have the recto fixed. he said i didn't have to wait on the mesh erosion scenario. however, this was told to me before i found out about the stupid surgeon stitching into my colon.....did you have culdoplasty done in any of your surgeries? if so, and you have ur med rec i'd really appreciate it if you'd look on surgical report and see if they mentioned stitching thru the surface of your colon????!!! geez.... what's worse is the surgeon knew i was already having problems due to a colonoscopy where they removed a pylop and apparantly knicked my colon. i was back in the hospital for 3 days....peritonitis....and the pain is continuously getting worse....while doing the reconstructive surgery he was supposed to have a gastro surg on hand in case he ran into problems w/ that i have my records i can't find any mention of any other dr, and well, then he did his thing...i don't know if i'm even a candidate for surgery now....still looking for competent dr...anyway, at least i know i'm not the only person out there facing this horrible possibility....are you looking at the prospect of more surgery due to mesh erosion? and what kind of testing are you having done that would determine whether you can have repairs for recto? just curious...thnx for the hugs....backatcha....don't forget the prayers....that's powerful stuff

Unread 04-01-2006, 07:31 AM
Mesh Erosion/Bowel Involvement?

No I only had a McCall's culdoplasty, which I believe is attaching the top of your vagina to the ligaments that used to hold up your uterus. But now that you mention it I will pay for a copy of my surgical report. I wish I had a copy of my surgical report from my original surgery back in 89 - just wondering exactly what that doctor did.
Anyway they didn't use any mesh during my hyst, cystocele repair and I wasn't leaking so I didn't need that repair either. I was going to insist if they had to use mesh that it be absorable not synthetic. So I can't help you there. One of the main reasons I chose not to have the rectocele repaired at the same time as the hyst was that I really want a colorectal specialist to do the surgery and somehow I didn't know how they would coordinate that, so I skipped it and decided to wait. Of course my rectocele got worse after surgery, so now I really can't wait - but I may not be a surgical candidate either. I am going to my gyn in 2 weeks for referrals to the colorectal doctor for tests. I think I have pretty much already had every test there is (except colonoscopy) but those were all 4 years ago - not looking forward to doing them again - some were so unpleasant and humilitating. I even went to physical therapy - totally useless.
I will post when I get some specifics - let me know what you find out.
Hugs and Prayers back to you too.

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