Laparoscopic sacrocolpopexy represents the gold standard in advanced prolapse repair [5]. Sacrocolpopexy might be more beneficial than transvaginal mesh surgery in terms of mesh-related complication rates, prolapse recurrence, and de novo dyspareunia [6]. Mesh complications occur infrequently but infections, failure of prolapse repair and mesh erosions necessitate mesh removal and repeat sacrocolpopexy if applicable [7].

However, the management of recurrent pelvic organ prolapse is challenging [5, 8] and data on this issue are scarce [5, 9]. Laparoscopic sacrocolpopexy has proven to be useful in recurrent pelvic organ prolapse after initial vaginal mesh surgery [5, 8] and repeat laparoscopic sacrocolpopexy does not differ from primary laparoscopic sacrocolpopexy or primary vaginal prolapse surgery regarding cure rates, complications, hospital stay, blood loss, and recurrence rates rendering re-do sacrocolpopexy a safe, effective, and feasible treatment option [5, 9, 10].

Laparoscopic sacrocolpopexy confers a low risk of mesh exposure of 0.7–1.4% [2, 11], and up to 8% after 2 and 10.5% after 7 years [7, 12]. The risk is increased in patients where the vagina was opened incidentally during the operation [11], and when the patients have a concomitant total hysterectomy the risk of erosion is up to 27.3%, [13] but no risk factors have been consistently shown to increase mesh erosion rates [12, 14]. In our first patient Gynemesh was used, which is known to induce strong foreign body inflammatory responses with activation of matrix metalloproteinases destroying collagen and elastin [15]. The surgical technique for laparoscopic sacrocolpopexy is hardly standardized, but the use of Amid Class I mesh (monofilament, macroporous) is broadly suggested [1] and titanium-coated polypropylene is sometimes recommended [11] to reduce mesh complications.

A conservative approach with topical estrogen can be attempted to treat mesh erosion, but surgical excision of the eroded mesh is necessary in up to 65.5% [2, 12]. Topical estrogen therapy is frequently ineffective, which is in line with data showing that premenopausal women and women on hormone replacement therapy are at an increased risk for mesh erosion [12].

In our patients the large eroded area required surgical treatment as the posterior vagina was almost completely involved. Recently, Panico et al described four main reasons for laparoscopic sacrocolpopexy mesh failure: mesh detachment from the sacral area, mesh detachment from the vagina, stretched mesh, or no clear cause [5]. We would add mesh erosion to these reasons because in our first patient the large area of erosion required further action and thus resulted in failure of the initial operation, and in both patients it is arguable whether the mesh had detached from the vagina or had never been placed correctly in the first place.

Given the high rate of recurrent prolapse a repeat sacrocolpopexy was carried out in the first patient, placing emphasis on accurate preparation and using a titanized polypropylene mesh. The other patient required repeat sacrocolpopexy owing to failure of the first attempt. The old mesh was removed to reduce the risk for infection and the quantity of implanted mesh, and to minimize the risk for shrinkage and erosion [5].