Tension-free vaginal tape Secur hammock procedure: two additional cases of intraoperative bleeding

Abstract

Dear Editor, Masata and colleagues [1] recently reported a case of severe bleeding following the use of tension-free vaginal tape (TVT) Secur (TVT-S) hammock (Ethicon Women Health, Sommerville, NJ, USA) for the treatment of stress urinary incontinence. The mini tape was used to avoid major complications, given the advantage of shorter length of the inserter, but 3 h after surgery, the patient developed a severe postoperative hemorrhage collecting in the Retzius space. The authors concluded that the scalpel-shaped tip of the inserter could have cut the fibres of the obturator muscle and advised that the best way to release the inserter without producing such complication was to hold the tape with thin scissors or with a small tampon. In our institution, we recently experienced two cases of intraoperative haemorrhages after five patients were treated with TVT-S procedure. Women were, respectively, 60 and 68 years old and required the procedure for the treatment of symptomatic urinary stress incontinence. No coagulopathies were present in the preoperative blood checks or were referred on history. In both cases, an intraoperative bleeding manifested after the scalpel-shaped tip of the inserter was introduced and perforated the right obturator muscle. Haemorrhages were immediately treated with prolonged intraoperative compressions of dressing gauzes and with vaginal packing for the following 24 h. In the early postoperative period, patients were carefully monitored, but did not develop any symptom of hypotension or pain in the abdomen. However, laboratory analyses revealed a loss of 2.6 and 3.2 U of haemoglobin between the preoperative (12.8 and 13.8 mg/dl) and postoperative values (9.6 and 11.2 mg/dl, respectively). Given the moderate haemorrhage and the asymptomatic clinical status, no ultrasound or computed tomography scans were performed, and patients were discharged home on the second postoperative day. After 1 month of follow-up, patients were still asymptomatic and incontinence symptoms were absent. We agree with Masata and colleagues that the most probable reason for intraoperative haemorrhages during the TVT-S procedure could consist in the large diameter of the inserter. In fact, although the new mini tape owns a short scalpel-shaped tip, useful to avoid major complications, it is unfortunately still too large to pass through the muscular fibres of the obturator muscles without cutting them, producing a diffuse oozing. Differently from Masata, the haemorrhages we experimented were less important and were treated with a conservative approach (prolonged compressions and vaginal packing). However, our cases further confirm that this complication can be present during TVT-S and should be taken into serious account by surgeons that believe this as a less invasive procedure for the treatment of stress urinary incontinence.

DOI: 10.1007/s00192-008-0673-0

Cite this paper

@article{Araco2008TensionfreeVT, title={Tension-free vaginal tape Secur hammock procedure: two additional cases of intraoperative bleeding}, author={Francesco Araco and Gianpiero Gravante and Francesco Sesti and Emilio Piccione}, journal={International Urogynecology Journal}, year={2008}, volume={20}, pages={125-125} }