Laparoscopic Burch surgery: is there any advantage in relation to open approach?

Abstract

Introduction: Surgery represents the main therapeutic modality for stress urinary incontinence. In incontinent patients with urethral hypermobility, the retropubic colposuspension by Burch technique is one of the surgeries that present better long-term results. Current trends towards performing minimally invasive techniques led proposing the Burch surgery through videolaparoscopy. The laparoscopic technique's long-term efficacy is a highly controversial issue. However, even if late results turn out to be satisfactory, the assumed advantages of laparoscopy (faster recovery, less pain, early return to daily activities, etc.) must be evident, in order to justify the use of this minimally invasive surgical access.Materials and Methods: We reviewed our records and analyzed the medical charts of 26 female patients who underwent Burch surgery by open approach and 36 female patients by laparoscopic approach, between May 1999 and February 2001. The satisfaction level, surgical complication rates, surgery length, hospital stay and return to daily activities were analyzed.Results: Mean age was 42 years, ranging from 27 to 68 years. Epidemiological data from both groups were not statistically different. Patients operated by laparoscopic route had a shorter hospital stay (p = 0.002) and a faster return to their daily activities (p < 0.001). However, there were no statistical differences in the following parameters: surgical time (p = 0.11), surgical complications (p = 0.98), patient satisfaction immediately (p = 0.77) and 90 days following surgery (p = 0.84), surgery acceptance (p = 0.85), indication of this surgery to a friend (p = 0.93) and score given to the procedure (p = 0.68).Conclusions: Even if the efficacy of both methods is similar, we did not observe significant advantages of laparoscopic surgery over open surgery, concerning the recovery in recent post-operative period.

Laparoscopic versus open colposuspension for urodynamic stress incontinence

“…The literature search identi¢ed 16 studies comparing the results of LC to OC for patients with SUI. These studies, published between 1995 and 2006 matched the selection criteria and were included in the analysis [Polascik, 1995;Burton, 1997;Kohli, 1997;Loveridge, 1997;Su, 1997;Miannay, 1998;Saidi, 1998;Summitt, 2000;Fatthy, 2001;Walter, 2002;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005Bezerra, 2004;Huang and Yang, 2004;Smith, 2005]. Analysis was performed on 16 studies, reporting on 1,807 patients, of whom 861 (47.6%) underwent laparoscopic and 946 (52.4%) underwent OC.…”

“…Three studies [Polascik, 1995;Loveridge, 1997;Ankardal, 2004] did not require patients to have pre-operative urodynamics. Five studies [Polascik, 1995;Loveridge, 1997;Miannay, 1998;Walter, 2002;Bezerra, 2004] Conversion to open surgery was reported in 26 cases out of 460 (5.7%), among seven studies [Burton, 1997;Saidi, 1998;Fatthy, 2001;Walter, 2002;Ankardal, 2004Ankardal, , 2005. Eight of the studies were RCTs.…”

“…In the remaining seven studies data collection for both groups was retrospective. Seven retrospective studies included matched groups [Polascik, 1995;Kohli, 1997;Loveridge, 1997;Miannay, 1998;Saidi, 1998;Bezerra, 2004;Huang and Yang, 2004], as follows: age [Polascik, 1995;Kohli, 1997;Loveridge, 1997;Miannay, 1998;Saidi, 1998;Bezerra, 2004;Huang and Yang, 2004], parity [Kohli, 1997;Loveridge, 1997;Miannay, 1998;Saidi, 1998;Bezerra, 2004;Huang and Yang, 2004], menopausal state [Saidi, 1998;Bezerra, 2004;Huang and Yang, 2004], HRT use [Saidi, 1998;Bezerra, 2004], previous abdomino-pelvic surgery [Polascik, 1995;Kohli, 1997;Loveridge, 1997;Miannay, 1998;Huang and Yang, 2004] and detrusor instability [Polascik, 1995;Bezerra, 2004].…”

“…The sensitivity analysis included 12 studies which scored eight or more stars on the modi¢ed Newcastle^Ottawa Scale [Polascik, 1995;Miannay, 1998;Saidi, 1998;Carey, 2000;Walter, 2002;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005Bezerra, 2004;Huang and Yang, 2004], ten that were published in or since 2000 [Carey, 2000;Summitt, 2000;Fatthy, 2001;Walter, 2002;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005Bezerra, 2004;Huang and Yang, 2004] and eight that were RCTs [Carey, 2000;Summitt, 2000;Fatthy, 2001;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005. The outcomes of interest reported by each study are summarized inTable II.…”

“…High quality studies (!8 stars), studies published after 2000, and RCTs only. Analysis of the high quality studies [Polascik, 1995;Kohli, 1997;Miannay, 1998;Saidi, 1998;Carey, 2000;Walter, 2002;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005Bezerra, 2004;Huang and Yang, 2004] and of studies published in or after 2000 [Carey, 2000;Summitt, 2000;Walter, 2002;Cheonetal., 2003;Ankardal, 2004Ankardal, , 2005Bezerra, 2004;Huang andYang,2004]mimickedtheoverallresults,withareductionin statistical heterogeneity (see Table IV). Analysis of RCTs [Carey, 2000;Summitt, 2000;Fatthy, 2001;Walter, 2002;Cheon et al, 2003;Ankardal, 2004Ankardal, , 2005 only showed that operative time was signi¢cantly longer in the laparoscopic group (WMD ¼ 18.38 min, 95% CI 1.39, 35.37, P ¼ 0.03) with heterogeneity in the results, while blood loss was lower (WMD ¼ À50.75 ml, 95% CI À79.82, À21.73, P < 0.001), as was length of hospital stay (WMD ¼ À1.39, 95 % CI À1.86, À0.92, P < 0.001) and return to normal activity (WMD ¼ À1.51weeks,95% CI À3.02,0.01, P ¼ 0.05) with LC (TableIV).…”