Peri- and Postoperative Complications in Abdominal, Vaginal Extraperitoneal, and Vaginal Intraperitoneal Colpopexy

TL;DR

This study compares surgical approaches for pelvic organ prolapse and finds similar complication rates but differences in hospital stay and operation time.

Contribution

The study identifies predictors of outcomes across different surgical approaches for sacral colpopexy.

Findings

The 30-day complication rate was similar across abdominal, vaginal extraperitoneal, and vaginal intraperitoneal approaches.

The vaginal extraperitoneal approach had the longest hospital stay and operation time.

The abdominal approach showed increased bleeding transfusions compared to the extraperitoneal approach.

Abstract

Introduction

Pelvic organ prolapse (POP) is a very common concern for women that can often necessitate surgical intervention, including sacral colpopexy. There are multiple surgical approaches, including vaginal, extraperitoneal, and intraperitoneal. This study aims to identify predictors of the outcomes with the different surgical approaches.

Methods

This retrospective study utilized data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) gynecologic-specific database for those who underwent sacral colpopexy for POP. The group was subdivided into surgical approaches that included abdominal, vaginal extraperitoneal, and vaginal intraperitoneal. ANOVA analysis was performed between the three groups, and a multivariate logistic regression was performed to determine the 30-day complication rate.

Results

Among the 1,275 cases analyzed, 326 (25.6%) utilized an abdominal approach, 425 (33.3%) utilized a vaginal approach, and 524 (41.1%) utilized an extraperitoneal approach. The mean age was significantly higher for patients undergoing a vaginal extraperitoneal (64.5 years) compared to abdominal (62.1 years) and vaginal intraperitoneal (61.6 years). There was no difference in the 30-day complication rate between the surgical approaches on adjusted analysis; however, the vaginal extraperitoneal approach had the longest hospital stay, days from operation to discharge, and total operation time.

Conclusion

A variety of surgical approaches for sacral colpopexy can be employed. In our study, we show that the 30-day complication rate was similar between the three approaches; however, the complications were only significant with the abdominal approach showing an increased occurrence of bleeding transfusions when compared to the extraperitoneal approach.