Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures
Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures
Background/aim: This study aimed to investigate differences in perioperative complications and short-term outcomes of patientswho underwent abdominal sacrocolpopexy/sacrohysteropexy, laparoscopic sacrocolpopexy/sacrohysteropexy, sacrospinous ligamentfixation (SSLF), and iliococcygeus fixation due to apical prolapse.Materials and methods: The present retrospective cohort study included 145 patients who underwent apical prolapse surgeryperformed by the same surgeons between 1/1/2011 and 30/6/2017. There were 68 abdominal sacrocolpopexies (44 sacrocolpopexies and24 sacrohysteropexies), 13 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 3 sacrohysteropexies), 57 SSLFs, and 7 iliococcygeusfixations. Patients’ short-term outcomes, perioperative complications, blood loss, operative time, and hospital stay were analyzed.Results: The mean operating time in the laparoscopic sacrocolpopexy group was 179.6 min versus 122.8, 117.3, and 107.1 min in theSSLF, abdominal sacrocolpopexy, and iliococcygeus fixation groups, respectively (P < 0.01). The hospital stay was significantly shorter inthe iliococcygeus fixation group (1.86 days) when compared with that of other groups (P < 0.01). During a 6-month follow-up period,no prolapse recurrence or mesh exposure was observed in any groups. Wound complications were more frequent in the abdominalsacrocolpopexy group. However, the overall complication rate of each group did not differ significantly (P = 0.332).Conclusion: Overall, complication rates and short-term outcomes for the abdominal, laparoscopic, and vaginal surgical procedureswere not statistically significantly different. However, minimally invasive approaches were associated with reduced procedural-relatedmorbidity.
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- Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff
E, Brown JS. Cost of pelvic organ prolapse surgery in the
United States. Obstet Gynecol 2001; 98: 646-651.
- [No authors listed.] Risk factors for genital prolapse in nonhysterectomized
women around menopause. Results from
a large cross-sectional study in menopausal clinics in Italy.
Progetto Menopausa Italia Study Group. Eur J Obstet Gynecol
Reprod Biol 2000; 93: 135-140.
- Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer
J, Spino C, Whitehead WE, Wu J, Brody DJ et al. Prevalence of
symptomatic pelvic floor disorders in US women. JAMA 2008;
300: 1311-1316.
- Barbalat Y, Tunuguntla HS. Surgery for pelvic organ prolapse:
a historical perspective. Curr Urology Rep 2012; 13: 256-261.
- Randall CL, Nichols DH. Surgical treatment of vaginal
inversion. Obstet Gynecol 1971; 38: 327-332.
- Cruikshank SH. Sacrospinous fixation--should this be
performed at the time of vaginal hysterectomy? Am J Obstet
Gynecol 1991; 164: 1072-1076.
- Porges RF, Smilen SW. Long-term analysis of the surgical
management of pelvic support defects. Am J Obstet Gynecol
1994; 171: 1518-1528.
- Beer M, Kuhn A. Surgical techniques for vault prolapse: a
review of the literature. Eur J Obstet Gynecol Reprod Biol 2005;
119: 144-155.
- Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff
G, Weber AM, Zyczynski H; Pelvic Floor Disorders Network.
Abdominal sacrocolpopexy: a comprehensive review. Obstet
Gynecol 2004; 104: 805-823.
- Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya
N, Brown J. Surgery for women with apical vaginal prolapse.
Cochrane Database Syst Rev 2016; 10: CD012376.
- McDermott CD, Hale DS. Abdominal, laparoscopic, and
robotic surgery for pelvic organ prolapse. Obstet Gynecol Clin
North Am 2009; 36: 585-614.
- Costantini E, Mearini L, Lazzeri M, Bini V, Nunzi E, di Biase
M, Porena M. Laparoscopic versus abdominal sacrocolpopexy:
a randomized, controlled trial. J Urol 2016; 196: 159-165.
- Sarlos D, Kots L, Ryu G, Schaer G. Long-term follow-up of
laparoscopic sacrocolpopexy. Int Urogynecol J 2014; 25: 1207-
1212.
- Demirci F, Ozdemir I, Somunkiran A, Topuz S, Iyibozkurt
C, Duras Doyran G, Kemik Gul O, Gul B. Perioperative
complications in abdominal sacrocolpopexy and vaginal
sacrospinous ligament fixation procedures. Int Urogynecol J
Pelvic Floor Dysfunct 2007; 18: 257-261.
- Coolen AL, van Oudheusden AM, van Eijndhoven HW,
van der Heijden TP, Stokmans RA, Mol BW, Bongers MY.
A Comparison of complications between open abdominal
sacrocolpopexy and laparoscopic sacrocolpopexy for the
treatment of vault prolapse. Obstet Gynecol Int 2013; 2013:
528636.
- Paraiso MF, Walters MD, Rackley RR, Melek S, Hugney C.
Laparoscopic and abdominal sacral colpopexies: a comparative
cohort study. Am J Obstet Gynecol 2005; 192: 1752-1758.
- Serati M, Bogani G, Sorice P, Braga A, Torella M, Salvatore S,
Uccella S, Cromi A, Ghezzi F. Robot-assisted sacrocolpopexy
for pelvic organ prolapse: a systematic review and metaanalysis
of comparative studies. Eur Urol 2014; 66: 303-318.
- Maher C, Feiner B, Baessler K, Schmid C. Surgical management
of pelvic organ prolapse in women. Cochrane Database Syst
Rev 2013; 4: CD004014.
- Hardiman PJ, Drutz HP. Sacrospinous vault suspension and
abdominal colposacropexy: success rates and complications.
Am J Obstet Gynecol 1996; 175: 612-616.
- David-Montefiore E, Garbin O, Hummel M, Nisand I. Sacrospinous
ligament fixation peri-operative complications in 195
cases: visual approach versus digital approach of the sacrospinous
ligament. Eur J Obstet Gynecol Reprod Biol 2004; 116:
71-78.
- Shull BL, Capen CV, Riggs MW, Kuehl TJ. Bilateral attachment
of the vaginal cuff to iliococcygeus fascia: an effective method
of cuff suspension. Am J Obstet Gynecol 1993; 168: 1669-1677.
- Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM.
Iliococcygeus or sacrospinous fixation for vaginal vault
prolapse. Obstet Gynecol 2001; 98: 40-44.
- Milani R, Cesana MC, Spelzini F, Sicuri M, Manodoro S, Fruscio
R. Iliococcygeus fixation or abdominal sacral colpopexy for
the treatment of vaginal vault prolapse: a retrospective cohort
study. Int Urogynecol J 2014; 25: 279-284.
- Serati M, Braga A, Bogani G, Leone Roberti Maggiore U, Sorice
P, Ghezzi F, Salvatore S. Iliococcygeus fixation for the treatment
of apical vaginal prolapse: efficacy and safety at 5 years of
follow-up. Int Urogynecol J 2015; 26: 1007-1012.
- Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri
L, Moran P, Slack M, Scott P, Waterfield M. A randomised
controlled trial of abdominal versus laparoscopic
sacrocolpopexy for the treatment of post-hysterectomy vaginal
vault prolapse: LAS study. Int Urogynecol J 2013; 24: 377-384.
- Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors
for prolapse recurrence after vaginal repair. Am J Obstet
Gynecol 2004; 191: 1533-1538.
- Diez-Itza I, Aizpitarte I, Becerro A. Risk factors for the
recurrence of pelvic organ prolapse after vaginal surgery: a
review at 5 years after surgery. Int Urogynecol J Pelvic Floor
Dysfunct 2007; 18: 1317-1324.
- Nieminen K, Huhtala H, Heinonen PK. Anatomic and
functional assessment and risk factors of recurrent prolapse
after vaginal sacrospinous fixation. Acta Obstet Gynecol Scand
2003; 82: 471-478.
- Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF,
Walters MD. Incidence of perioperative complications of
urogynecologic surgery in elderly women. Am J Obstet
Gynecol 2005; 192: 1630-1636.
- Bradley CS, Kenton KS, Richter HE, Gao X, Zyczynski
HM, Weber AM, Nygaard IE; Pelvic Floor Disorders Network.
Obesity and outcomes after sacrocolpopexy. Am J Obstet
Gynecol 2008; 199: 690.e1-8.