Laparoscopic sacrocolpopexy is as safe in septuagenarians or elder as in younger women

Abstract

Background Data concerning laparoscopic sacrocolpopexy (LSCP) in elder women are scarce. We compared intra-operative and early-postoperative complications associated with laparoscopic colpo-, cervico-, or hysteropexy in women under and above 70 years. Methods Retrospective assessment by an independent investigator of a prospective cohort of 571 consecutive women undergoing LSCP in a tertiary unit over an 18-year period. Data included were patient demographics, operative variables, intra-operative, and early (≤ 3 months) postoperative complications. Complications were graded according to the Clavien-Dindo classification and mesh complications categorized using the International Urogynaecological Association (IUGA)-classification. Findings Median age was 66 (IQR 15, range 27-91) and 204 (35.7%) patients were older than 70 years. There were no deaths. Strategic conversion rate was 2.3% (13/571), the majority because of extensive adhesions yet early in our experience. Reactive conversion rate was 0.7% (4/571). Among 554 patients who had a completed LSCP, there were 20 intra-operative complications (3.6%), mostly bladder (1.3%) and vaginal (1.1%) injuries. Eighty-four patients had a total of 95 early-postoperative Dindo ≥ II complications (15.1%). Most common complications were infectious and treated medically (Dindo II). Clinically major complications are rare (III = 3.1% and IV = 0.2%). Reoperation for suspected bleeding (IIIb = 0.7%) was the most common reintervention, typically without demonstrable cause. Most mesh complications were vaginal exposures. Septuagenarians were not more likely to have an intra-operative (4.0 vs 3.3% < 70 years, p = 0.686) or early-postoperative complication (13.6 vs 16.0% < 70 years, p = 0.455) than younger patients. Mesh complications were also equally uncommon. Conclusions LSCP is as well-tolerated by women above 70 years as by younger women.

Learning curves of open and endoscopic fetal spina bifida closure: systematic review and meta‐analysis

“…It precludes determining an exact number of cases required to overcome the LC. Block size was set at 30 cases, based on previous studies on the LC for advanced laparoscopic adult digestive 17 , gynecologic 18,19 , pediatric 20 and fetal 21 surgeries, which showed a plateau after 30 cases. In this study, competency was defined when the procedure provided results similar to those in the MOMS trial for clinically relevant and reliable variables that are representative for: (1) immediate surgical outcome (six variables); (2) short-term neonatal neuroprotection (four variables); and (3) long-term neuroprotection at ≥ 1 year of age (three variables) 3,22 .…”

Medium‐term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study

“…We are conducting an ongoing prospective cohort study, including all patients undergoing LSCP at our unit . The cohort was initiated in 1998 and consequently includes all patients from the first laparoscopic case onwards.…”

“…Our follow‐up method has also been reported in detail elsewhere . In brief, standard follow‐up visits are at 6 to 12 weeks and 12 months postoperatively, whereafter most patients come yearly.…”

“…When patients were unable or declined to attend, a standardized telephone interview was taken to document the functional outcome . Patients declining any evaluation, who died or had cognitive or physical limitations, and hence could not be properly assessed, are reported yet considered as lost to follow‐up …”

“…Postoperative complications within 3 months were categorized using the Clavien‐Dindo surgical classification system (Table ). As before, we reported all category‐II or higher complications in detail . GRCs were classified using the International Urogynecological Association/International Continence Society (IUGA/ICS)‐standardized terminology .…”