Perioperative hemorrhagic complications in pelvic floor reconstructive surgery

Abstract

Hemorrhagic complications during or after pelvic floor reconstructive surgery are rare. Mesh use and concomitant VH are two major surgical risk factors for hemorrhagic complications in pelvic floor reconstructive surgery.

Colpocleisis as an obliterative surgery for pelvic organ prolapse: is it still a viable option in the twenty-first century? Narrative review

“…In a study comparing total colpocleisis with vaginal hysterectomy (VH) versus total colpocleisis of the vaginal vault, VH was associated with a significant increase in absolute change in hematocrit (11.9% vs 9.5%, p = 0.01) and the need for transfusion (35.1 vs 12.7%, p = 0.02) [ 37 ], which was confirmed in a later study, in 2019. Women undergoing total colpocleisis with VH had a higher hemoglobin drop (15 ± 12 vs 11 ± 9 g/L, p = 0.006) and red blood cell (RBC) loss (196 ± 150 vs 140 ± 117, p = 0.01) than women with colpocleisis alone [ 48 ]. Hill et al reported higher blood loss (253 vs 146 ml, p = 0.01), higher transfusion rate (9.3% vs 4.3%, p = 0.02), and longer operative time (144 vs 111 min, p < 0.001) with concomitant VH [ 42 ].…”

“…The patients who underwent colpocleisis received the lowest mean morphine milligram equivalent (MME) (137.6 ± 99.8 mg) than other reconstructive surgeries, with the highest mean MME prescribed to patients undergoing laparoscopic uterosacral ligament suspension (214.1 ± 87.5 mg) ( p < 0.0001) [ 51 ]. In addition, hemoglobin drop in colpocleisis was significantly lower than in the reconstructive procedures ( p < 0.05) [ 48 ].…”

“…The rates of concomitant VH also differ across the centers, but the procedure is typically associated with a risk of higher blood loss [ 37 , 48 ] and prolonged operative time [ 44 ]. In turn, according to different decision analysis models, the protective value of VH against unanticipated pathology and malignancy in the uterus can be observed only in younger women (<40 years of age) [ 3 ].…”

Systematic review and meta-analysis of therapeutic effects of pelvic restoration combined with anti-stress urinary incontinence surgery on pelvic floor dysfunction

“…After downloading the remaining literatures, 5 literatures with "unclear grouping" and 6 literatures with "outcome index data is not uniform" were removed. Finally, a total of 6 literatures meeting the requirements were included in the Mata analysis (11)(12)(13)(14)(15)(16). The retrieval process was shown in Figure 1, and the basic information of the included literature was shown in Table 1.…”

“…In this mate-analysis, 8 articles (11)(12)(13)(14)(15)(16)(17)(18) the 8 articles, a total of 6 studies reported information such as age, follow-up time, and observation indicators. Between the experimental group and the control group, there was no statistically significant difference (P>0.05).…”