Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes

Abstract

BackgroundUterovaginal prolapse in very elderly women is a growing problem due to increased life expectancy. Surgeons and anaesthetists may be wary of performing quality of life surgery on this higher risk group. Where surgery is undertaken, it is commonly performed vaginally; there is a perception that this is better tolerated than abdominal surgery.Little data is published about laparoscopic prolapse surgery tolerability in this population, and laparoscopic surgery is perceived within the urogynaecological community as complex and lengthy and hence inherently unsuitable for the very elderly.In Oxford, UK, laparoscopic abdominal surgical techniques are routinely employed for urogynaecological reconstructive surgery. The authors offer abdominal laparoscopic prolapse surgery to patients suitable for general anaesthesia with apical vaginal prolapse, irrespective of age. We here report outcomes in this elderly patient cohort and hypothesise these to be acceptable.This is a retrospective case note review of all patients aged 79 years old and above undergoing laparoscopic prolapse surgery (hysteropexy or sacrocolpopexy) in two centres in Oxford, UK, over a 5-year period (n = 55). Data were collected on length of surgery, length of stay, intraoperative complications, early and late post-operative complications and surgical outcome.ResultsMean age was 82.6 years (range 79–96). There were no deaths. Minor post-operative complications such as UTI and constipation were frequent, but there were no serious (Clavien-Dindo grade III or above) complications; 80% achieved objective good anatomical outcome.ConclusionsLaparoscopic prolapse surgery appears well tolerated in the elderly with low operative morbidity and mortality.

Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study

“…Our findings concur with those of Boudy et al [27] who analyzed 47 women aged 70 or more, who constituted 24.6 % of their study participants, and found comparable low frequencies of perioperative complications [27]. In view of the retrospective nature of the studies that have reported on LSC outcomes in different age groups and the lack of availability of the total number of women who presented with a significant a-POP during the studied periods we were not able to calculate their actual feasibility rates for undertaking this procedure in older age, and hence higher operative risk, groups [27,27,28,29]. In contrast, in our study LSC was offered to 85.5 % of the women with a preoperative ASA-PS!3.…”

“…We did not identify other studies that have assessed LSC outcomes in relation to ASA-PS scores to compare our results to. Nevertheless, there are several studies that assessed LSC operative outcomes in relation to women's age [26][27][28][29]. In a study by Turner and colleagues where participants had a mean age of 58.5 years, they reported higher perioperative complication rates amongst women who were !65 years at the time of the procedure [26].…”