Bowel Obstruction After Sacrocolpopexy: A Case Series

Three-Year Outcomes of a Multicenter Study of Japanese-Style Laparoscopic Sacrocolpopexy

INTRODUCTION AND HYPOTHESIS

Laparoscopic sacrocolpopexy(LSC) is widely performed and has been reported to safe and effective. However, statistical data on this technique are unavailable. Therefore, we designed the Japanese-style LSC, a further evolution of the French-style LSC, and initiated this multicenter study to prospectively evaluate its efficacy and safety. If the Japanese-style LSC is successful, we may be able to propose a more reliable and standardized procedure.

METHODS

This is a prospective study of Japanese-style LSC. The Japanese-style LSC is characterized by the dissection of the vaginal walls as distally as possible and fixation of the mesh with multiple sutures; fixation of the mesh on the promontory without traction; and closure of the peritoneum with high-level peritoneal sutures. We examined the primary (anatomical recurrence, adverse events, and quality of life) and secondary endpoints (voiding symptoms and sexual function) at 3 years postoperatively.

RESULTS

In anatomical recurrence, 24 patients (9.2%) were ≥ stage2 in the Pelvic Organ Prolapse Quantification system at 3 years postoperatively, of which 4 (1.5%) and 20 (7.7%) were stages III and II respectively. No mesh-related complications were observed, and each questionnaire showed predominant improvement, except for sexual and evacuation functions.

CONCLUSIONS

The Japanese-style LSC demonstrated superior anatomical and functional results and we propose it to be an effective procedure.

The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure

Background

Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting.

Methods

In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05.

Results

Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01‒1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33‒18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure.

Conclusion

The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.

Sacrocolpopexy experience with a novel robotic surgical platform

INTRODUCTION AND HYPOTHESIS

The objective was to describe early experience performing sacrocolpopexy using a novel robotic surgical platform.

METHODS

This is a case series of all women who underwent robotic-assisted sacrocolpopexy using a new robotics platform (TransEnterix Senhance) between January 2019 and July 2021. All sacrocolpopexies were performed by a single Female Pelvic Medicine and Reconstructive surgeon at a large academic institution. Perioperative information including complications was abstracted from the medical record. Anatomical recurrence was defined as any anatomical point at or past the hymen (≥0). Data are descriptive, with Mann-Whitney U test used for comparison of operative time between the first and second half of the patients.

RESULTS

A total of 25 sacrocolpopexies were performed using the new robotics platform. Mean age was 62.3 years (±9.2) and mean BMI was 26.5 (±3.8). Ten (40.0%) patients had a prior hysterectomy. Most (n = 21, 84.0%) had stage III or IV prolapse preoperatively. Mean operative time was 210.2 min (±48.6) and median estimated blood loss was 35 ml (IQR 25-50). Mean operative time decreased between the first and second half of the patients (231.7 min vs 190.3 min, p = 0.047). There were no major intraoperative complications. Median follow-up time was 16 weeks (IQR 4-34) and there were no subjective recurrences or retreatments during this period. Two patients (8.0%) had anatomical recurrence without subjective bother. There were two postoperative readmissions (8.0%) within 30 days for small bowel obstruction, one treated surgically and the other with nonsurgical management.

CONCLUSIONS

Our case series demonstrates feasibility and successful early adoption of a new robotics platform for robotic sacrocolpopexy.