National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension

Chapman, Graham; Slopnick, Emily; Roberts, Kasey; Sheyn, David; Wherley, Susan; Mahajan, Sahil; Pollard, R.R.

doi:10.1016/j.jmig.2020.05.015

Cited by 14 publications

(9 citation statements)

References 17 publications

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“…However, it occurs more often in SSLF than in USLS, with a longer duration; the degree of pain is more severe in SSLF, with more drug treatment needed, some even needing surgical removal of sutures (Barber et al, 2019; Dangal et al, 2018; Detollenaere et al, 2015). For hemorrhage, previous studies have reported that SSLF may lead to severe bleeding; we found that the intraoperative blood transfusion rate of USLS can be 0.9%–2.3%, which is similar to that of SSLF (Table 4) (Chapman et al, 2021; Detollenaere et al, 2015; Nager et al, 2019; Pahwa et al, 2016). Urinary system injury usually occurs in USLS (Jackson et al, 2015; Nager et al, 2019).…”

Section: Commentssupporting

confidence: 81%

“…In pelvic floor reconstruction, perioperative complications management is challenging, especially for apical suspension. The two classic apical suspension methods are SSLF and USLS; both can have severe perioperative complications, but with a few differences (Table 4) (Barber et al, 2019; Chapman et al, 2021; Dangal et al, 2018; Detollenaere et al, 2015; Greisen et al, 2021; Jackson et al, 2015; Nager et al, 2019; Siddiqui et al, 2021; Yadav et al, 2021; Zhu et al, 2021). Suture‐related pain ranges from 0% to 8.7% in USLS.…”

Section: Commentsmentioning

confidence: 99%

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Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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Sacrospinous ligament fixation (SSLF) is one of the most used native tissue approaches for apical suspension with a high rate of perioperative complications. This study aimed to review cases undergoing a modified SSLF and assess its perioperative adverse events. It was a retrospective study of 168 consecutive patients undergoing modified transvaginal SSLF at a single tertiary center from 2017 to 2021. The sutures were placed on the sacrospinous ligament (SSL) approaching the sacrum through natural spaces under direct vision. Moreover, it was performed bilaterally. Patient demographics and perioperative complications were reviewed. The median age was 65 years, and 85.7% (144/168) had stage III–IV prolapse. Among the 168 patients undergoing this modified SSLF, 161 were for uterovaginal prolapse, and seven were for posthysterectomy vaginal vault prolapse. 83.9% (135/161) patients were concomitant with hysterectomy, and 70.2% (118/168) were with anteroposterior colporrhaphy. The median operation time was 82 min (interquartile range [IQR], 61–100 min), and the median intraoperative blood loss was 50 ml (IQR, 30–50 ml). Two cases had pelvic hematoma, and both were cured after expectant treatment. No patient required a homologous blood transfusion, and none complained about buttock or lower limb pain 2 weeks postoperatively. Nor did injury of the ureters, bladder, or rectum occur intraoperatively. This modified transvaginal SSLF procedure was safe and had no severe perioperative complications.

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Section: Commentssupporting

confidence: 81%

Section: Commentsmentioning

confidence: 99%

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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“…In these studies, the serious complications rates ranged from 3.2% to 5.6% in the VH cohorts. 15,16 These estimates are higher than in our cohort, likely because of the inclusion of those with more medical complexity and longer admissions.…”

Section: Discussioncontrasting

confidence: 56%

“…While the study was underpowered in this subset with less than 1,000 SDD cases, our findings are consistent with prior data evaluating the safety of SDD after prolapse repair at time of minimally invasive hysterectomy. 11,13,15,16,21 Median time to complications was also evaluated. Same-day discharge had an earlier time to CCs and reoperation when compared with NDD (11 vs 13 days for CCs and 11 vs 15 days for reoperation).…”

Section: Discussionmentioning

confidence: 99%

“…Predicate data for 30-day complications after VH are sparse and range from 0.7% to more than 7% depending on cohort and outcome analyzed. [14][15][16] The authors thus based the sample size calculation on literature review, expert opinion, and best estimates expected for our low-risk cohort. To detect a difference between a CC rate of 2.5% for SDD and 1.5% for NDD, we would need 3,076 participants per group given an α value of 0.05 and power of 0.80.…”

Section: Methodsmentioning

confidence: 99%

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Perioperative Outcomes for Same- Versus Next-Day Discharge After Benign Vaginal Hysterectomy

Burger,

Robison,

Nekkanti

et al. 2024

UROGC

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Importance While same-day discharge (SDD) after laparoscopic hysterectomy is well supported, studies for vaginal hysterectomy (VH) are lacking. Objective The aim of the study was to compare 30-day complications for SDD versus next-day discharge (NDD) after benign VH. Study Design This was a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2019. Vaginal hysterectomy with or without urogynecology procedures was identified by Current Procedural Terminology codes. The primary outcome was 30-day composite complications of SDD versus NDD after VH. Secondary outcomes compared reoperations rates, time to and reasons for reoperation, and complications between the groups. Composite complications included death, major infection or wound complication, thromboembolism, transfusion, cardiopulmonary complication, renal insufficiency/failure, stroke, or reoperation. Unadjusted and adjusted odds ratios were determined using univariate and multivariate analysis. Results Of 24,277 people included, 4,073 (16.8%) were SDD, which were more likely to be younger (P < 0.001), less likely to have hypertension (23.4 vs 18.3%, P < 0.0001) or diabetes (4.5 vs 3.3%, P = 0.001), and had shorter surgical procedures (100.7 ± 47.5 vs 111.2 ±57.5 minutes, P < 0.0001). There was no difference in composite complications after SDD versus NDD and this remained true in multivariate analysis (2.0 vs 2.3%, P = 0.30, SDD; adjusted odds ratio, 0.9; 95% confidence interval, 0.7–1.1). There was no difference in reoperation rates (0.9 vs 0.9%, P = 0.94) or reasons for reoperation. Time to first complication was shorter for SDD versus NDD (11 vs 13 days, P = 0.47). Conclusion In our cohort of low-risk patients, SDD after VH with or without urogynecology procedures did not have an increased odds of 30-day composite complications.

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Systematic review and meta‐analysis of the pelvic organ prolapse and vaginal prolapse among the global population

Mudalige,

Pathiraja,

Delanerolle

et al. 2024

BJUI Compass

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BackgroundPelvic organ prolapse (POP) occurs when one or more pelvic organs (uterus, bowel, bladder or top of the vagina) descend from their normal position and bulge into the vagina. Symptoms include pelvic discomfort, fullness, and changes in bladder or bowel function. Treatment ranges from conservative approaches to surgery, depending on symptom severity. Surgical methods include vaginal wall repair, with or without hysterectomy, or via laparoscopic, robotic or open techniques. Common complications include bleeding, infection, and urinary or bowel dysfunction.MethodsA systematic review was conducted, and a protocol was registered with PROSPERO (CRD42022346051). Publications from 30 April 1980 to 30 April 2023 were retrieved from multiple databases. Data were analysed using random‐effects and common‐effects models with subgroup and sensitivity analyses.FindingsForty‐four studies met the inclusion criteria, with 29 studies used for meta‐analysis of vaginal prolapse surgery outcomes. Sixteen studies focused on patients who had undergone hysterectomy alongside prolapse repair.InterpretationPatients who underwent vaginal prolapse surgery with hysterectomy experienced higher operative and postoperative complication rates than those without hysterectomy. Increased risks included hospital readmission, POP recurrence and re‐operation. The review highlighted a lack of diversity in terms of ethnicity, age and comorbidity status, which are essential to fully understanding the impact of POP. Future research should focus on these underrepresented factors.

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National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at the Time of Uterosacral Ligament Suspension

Cited by 14 publications

References 17 publications

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

Perioperative Outcomes for Same- Versus Next-Day Discharge After Benign Vaginal Hysterectomy

Systematic review and meta‐analysis of the pelvic organ prolapse and vaginal prolapse among the global population

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