骨盤臓器脱メッシュ手術後の再発に対するTVM手術の1例

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A 61-year-old woman presented with the chief complaint of a vaginal bulge for 2 years. She had undergone two operationsfor pelvic organ prolapse. The initial procedure wasthe Manchester procedure and posterior colporrhaphy, and the second was a vaginal repair with mesh for recurrent rectocele 3 years after the initial surgery. She noticed the vaginal bulge shortly after the second surgery. A gynecological examination revealed a stage III rectocele associated with a 2 cm, firm mass at the posterior vaginal wall. T2-weighted magnetic resonance imaging showed a 2×3 cm high-intensity mass located between the vaginal wall and rectum. The recurrent rectocele might have been caused by incomplete support from the mesh, which was not fixed in the vaginal wall, resulting in formation of a mass. The patient underwent complete mesh removal and tension-free vaginal mesh-posterior surgery for the rectocele. The excised mesh had shrunk froma 7×5 cm rectangle mesh preoperatively into a firm 2×2×3 cm mass. No recurrence has been seen for 18 months postoperatively.