The Impact of Obesity on Intraoperative Complications and Prolapse Recurrence After Minimally Invasive Sacrocolpopexy

Turner, Lindsay C.; Lavelle, Erin Seifert; Lowder, Jerry L.; Shepherd, Jonathan

doi:10.1097/spv.0000000000000278

Cited by 25 publications

(20 citation statements)

References 27 publications

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“…This study builds on previous studies comparing short-term outcomes after sacrocolpopexy and vaginal surgery between normal weight, overweight, and obese patients by assembling a cohort of overweight and obese patients that is much larger than the largest cohort represented in these single-center retrospective studies. [12][13][14][15][16]20 In addition, we expanded on the analysis of women of all BMI classes by Linder et al 11 by constructing a robust prespecified multivariable model adjusting for more preoperative comorbidities to isolate the contribution of BMI to the odds of complication by surgical approach in the setting of the known increased chronic disease burden in this population. 30 Strengths of this study include that the cohort represents a North America-wide, population-based sample comprising both tertiary and community sites derived from a validated source with an established mechanism to minimize loss to follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Comparisons of apical repair surgical approaches have been completed in a population of patients across all body mass index (BMI) categories and no difference was found in short-term outcomes between approaches. 10,11 Several studies have compared outcomes following vaginal surgery 12,13 and sacrocolpopexy [14][15][16][17][18][19][20] between obese and nonobese patients noting higher complication rates in obese patients. In addition, several systematic reviews have examined complications between approaches, but these have not compared approaches in patients with elevated BMI.…”

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confidence: 99%

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Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Stairs

Minassian

Clancy

2022

Female Pelvic Med Reconstr Surg

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Importance: Overweight and obese women represent a growing share of pelvic floor reconstruction surgeons' practices. Determining perioperative risk specific to this population is essential to inform decision making regarding operative approach in this population. Objective:The aim of the study was to compare surgical complications among overweight and obese women undergoing apical compartment prolapse surgery by either minimally invasive abdominal or vaginal approach.Study Design: The American College of Surgeons National Surgical Quality Improvement Database was used to identify overweight and obese patients (body mass index ≥ 25) undergoing either minimally invasive sacrocolpopexy (MISC) or vaginal vault suspension (VVS) in the form of a sacrospinous vault fixation or uterosacral ligament fixation for pelvic organ prolapse from 2012 to 2019. Odds ratios for surgical complications, readmission, and reoperation were estimated using multivariable logistic regression.Results: Of 8,990 eligible patients, 5,851 underwent a VVS and 3,139 patients underwent MISC. There was a greater odds of any complication in the first 30 days following VVS (n = 608 [10.4%]) compared with MISC (n = 247 [7.9%]; odds ratio, 1.27; 95% confidence interval, 1.08-1.48) on multivariable analysis. Urinary tract infections (UTIs) were the most common complication and were more likely following VVS (112 (3.6%) versus 350 (6.0%), P < 0.001). When UTIs were excluded, there was no difference in complications between approaches (1.00; 95% CI, 0.82-1.22). There were no statistically significant odds of readmission, reoperation, or serious complications between approaches. Conclusions:Vaginal vault suspension may be associated with a higher odds of any complication compared with MISC in overweight and obese women, but the rate of serious complications, readmission, and reoperation are low, and approaches were comparable when considering complications other than UTI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Stairs

Minassian

Clancy

2022

Female Pelvic Med Reconstr Surg

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“…A study by Turner et al evaluated complication rates and outcomes in normal weight, overweight and obese women undergoing both robotic sacrocolpopexy (RSC) and LSC reported that obese women were more likely to undergo RSC ( p = 0.004 ) [13]. They found increased blood loss in obese women ( p = 0.003 ), although total blood loss was not clinically significant, at <100 ml, for all groups, which is in keeping with our findings.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic sacrocolpopexy posthysterectomy: intraoperative feasibility and safety in obese women compared with women of normal weight

et al. 2019

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Introduction and hypothesisOur aim was to determine the intraoperative feasibility and complication rate of laparoscopic sacrocolpopexy (LSC) in overweight and obese women compared with women of normal weight.MethodsThis was a retrospective observational cohort study (Canadian Task Force classification II-2) conducted at a tertiary urogyaenocology unit evaluating 119 women who underwent LSC between March 2005 and January 2013.ResultsBody mass index (BMI) was classified as normal (22.89 ± 1.55), overweight (27.12 ± 1.40) and obese (33.47 ± 3.26) according to the World Health Organisation (WHO) classification. There was no difference in intraoperative complication rates for bladder, bowel, ureteric or vascular injury; haemorrhage; conversion to laparotomy; or anaesthetic complications for normal weight, overweight or obese women. Similarly there was no difference in operating time, duration of anaesthetic or hospital stay between BMI class (p = 0.070, p = 0.464, p = 0.898, respectively) postoperative or mesh complication rates. At 6-months’ follow-up, there was no difference in Patient Global Impression of Improvement scale (PGI-I) (defined as very much better or much better) between normal weight, overweight and obese women (76.9, 72 and 65.4%, p = .669) or objective cure using the Pelvic Organ Prolapse Quantification (POP-Q) examination (p = 0.402).ConclusionsLSC is feasible, with equivalent intraoperative complication rates for normal weight, overweight and obese women when performed by experienced laparoscopic urogynaecologists. Given the benefits of a laparoscopic approach in obese women, the authors suggest they should be offered LSC as an option to treat vault prolapse when surgical management is being considered.

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“…The patients were divided according to preoperative BMI into two groups, i.e., nonobese (BMI <30) and obese (BMI ≥30). [ 15 ] The inclusion criteria for this study were LSC with concomitant supracervical hysterectomy (SCH) or UP for preoperative POP-Q stage II or higher. The general stage of POP was defined as the most severe stage in one or more of the anterior, apical, and posterior vaginal compartments.…”

Section: Aterials and M Ethodsmentioning

confidence: 99%

Medium-term risk of recurrent pelvic organ prolapse within 2-year follow-up after laparoscopic sacrocolpopexy

Sato

Otsuka

Abe

et al. 2023

Gynecol Minim Invasive Ther

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Objective: The present study was performed to determine the risk of recurrent pelvic organ prolapse (POP) within 2 years after laparoscopic sacrocolpopexy (LSC) in patients with uterovaginal prolapse. Materials and Methods: A retrospective comparative study was performed in a population of 204 patients over a 2-year follow-up period following LSC with concomitant supracervical hysterectomy or uterine preservation at a single urological clinic between 2015 and 2019. The primary outcome was surgical failure following LSC in cases of POP, focusing on failures occurring before the 2 nd year of follow-up. Logistic regression analysis was used to determine the odds ratios (ORs) for surgical failure. Results: The primary outcome, surgical failure in cases of POP, occurred 2 years after the initial surgery in 19 of the 204 patients (9.3%) (95% confidence interval [CI], 5.7% – 14.2%). Surgical failure was most common in the anterior compartment ( n = 10, 4.9%), and further surgery was performed in seven of the patients with surgical failure (3.4%). The poor primary outcome was predicted by lysis of adhesions (OR, 7.5, 95% CI, 1.6–33.8, P = 0.008) and preoperative POP stage IV (OR, 3.5; 95% CI, 1.1–10.8, P = 0.03) on multivariable logistic regression analysis. Conclusion: The overall rate of surgical failure following LSC in our cohort was 9.3% over the 2-year follow-up period after surgery, and preoperative prolapse stage IV was associated with a higher risk of recurrence.

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The Impact of Obesity on Intraoperative Complications and Prolapse Recurrence After Minimally Invasive Sacrocolpopexy

Cited by 25 publications

References 27 publications

Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Complications After Vaginal Vault Suspension Versus Minimally Invasive Sacrocolpopexy in Women With Elevated Body Mass Index: A Retrospective Cohort Study Using Data From the National Surgical Quality Improvement Program Database

Laparoscopic sacrocolpopexy posthysterectomy: intraoperative feasibility and safety in obese women compared with women of normal weight

Medium-term risk of recurrent pelvic organ prolapse within 2-year follow-up after laparoscopic sacrocolpopexy

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