The management of pelvic organ prolapse in England: a 4-year analysis of hospital episode statistics (HES) data

Should we use a vaginal pack to reduce blood loss at the time of prolapse surgery?

OBJECTIVE

Vaginal packs are commonly inserted after pelvic organ prolapse (POP) surgery to absorb excess blood loss and to reduce haematoma formation. Randomised trials have shown little benefit in terms of reduced haematoma formation. However, the amount of blood loss absorbed on the pack has not been studied. The use of packs has financial costs and is associated with catheterisation and may delay hospital discharge. If packs are not effective in reducing blood loss and haematoma formation there could be an argument that packs should not be used at all. This study was designed to identify how much blood is actually absorbed onto packs after POP surgery.

STUDY DESIGN

Consecutive patients undergoing elective vaginal surgery for POP were prospectively recruited by the lead author. Demographics were recorded. Vaginal packs inserted after POP surgery in 63 women were weighed before insertion and at the time of removal the day after surgery. Pain score were noted and the difference in the weight of packs recorded. Any complications were reported by the patients at the 6 week routine post operative visit and cross referenced with the clinical records.

RESULTS

There was a statistically significant increase in pack weight of 6.7g (p<0.01). Five percent of the patients had a bleed of more than 25g into the pack. Removal of the pack was associated with minor discomfort. Complications in the post operative period were low with 11% of patients seen in the first 6 weeks with bleeding or discharge.

CONCLUSION

The majority of women undergoing prolapse surgery have minimal bleeding onto a routinely introduced vaginal pack placed after POP surgery. Packs are probably not required for controlling post operative blood loss in the majority of patients.

Anatomic Outcomes of Robotic Assisted Supracervical Hysterectomy and Concurrent Sacrocolpopexy at a Tertiary Care Institution at Initial Adaptation of the Procedure

OBJECTIVE

The aim of the study was to review anatomic and surgical outcomes of robotic-assisted supracervical hysterectomy (RASCH) with concurrent sacrocolpopexy in the treatment of primary pelvic organ prolapse (POP) on initial adaption of this procedure.

STUDY DESIGN

A retrospective chart review of patients undergoing RASCH with concurrent sacrocolpopexy between 2009 and 2012 was performed at a tertiary care academic institution, after initial adaption of this procedure. The primary outcome was change in vaginal support (assessed with the pelvic organ prolapse quantification [POP-Q]) at 3 months and 1 year postoperatively. Secondary measures assessed included estimated blood loss, operative times, hospital length of stay, and operative complications.

RESULTS

Forty patients (N = 40) underwent RASCH with concurrent sacrocolpopexy. Twenty-six patients (65%) had preoperative stage II POP, and 35% had stage III POP. Three months after undergoing the procedure, 55% had achieved stage 0 POP. An additional 35% were categorized as stage I POP. At 1 year, 72.7% were stage I POP or lower. The mean (SD) operating time was 275 (82.3) minutes. Estimated blood loss and mean (SD) length of hospital stay were 163 (114.9) mL and 1.3 (0.8) days, respectively. There were no intensive care unit admissions. The most common postoperative complication was immediate urinary retention in 10% of patients; all cases resolved with time-limited intermittent self-catheterization.

CONCLUSIONS

Even with initial adaptation of the procedure, RASCH with concurrent sacrocolpopexy for the repair of primary POP is effective in restoring anatomic support in the short term. Operative complications are minimal.