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Spondylodiscitis after minimally invasive recto- and colpo-sacropexy.

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eMediNexus    17 November 2018

The objective of a new study published in the Journal of Minimal Access Surgery was to identify case studies or case series reporting on spondylodiscitis (SD) after rectopexy or colpopexy. Here, a systematic literature search was performed with the main outcomes measures, time from initial surgery to SD, presenting symptoms, occurrence of mesh erosion or fistula formation, and type of treatment. The results revealed that 41 females with a median age of 59 (54-66) years were diagnosed with SD after a median of 76 (30-165) days post initial surgery. Most common presenting symptoms were back pain (in 35), fever (in 20), pain radiation in the legs (in 9), and vaginal discharge (in 6). Meanwhile, a mesh erosion or fistula formation was detected in only a few. The management of SD comprised conservative treatment with antibiotics in 29%, whereas 66% of the patients had to undergo additional surgical treatment. In cases where revision surgery was necessary, more than one intervention was performed in 40%. Mesh and tack excision was performed in 21 women and a neurosurgical intervention was required for 10 women. From the findings, it was concluded that though SD is a rare complication, surgeons performing rectopexy and colpopexy must be aware of its potential risk. Careful suture or tack placement into the anterior longitudinal ligament at the level of the promontory, while avoiding the disc space, is of paramount importance. Prompt diagnosis and multidisciplinary management are the cornerstones of a successful treatment.

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