The choice of reoperation after primary surgeries for uterine prolapse: A nationwide study

Abstract

a b s t r a c tObjective: Our previous study described the increasing adoption of uterine-preserving procedures in the surgical approach for uterine prolapse. In this follow-up study, we further explored the reoperation rate and variables for the choice of surgeries after primary uterine prolapse surgery, based on the nationwide claim data in Taiwan. Materials and methods: The data of this study was obtained from the Inpatient Expenditures by Admission files of the National Health Insurance Research Database (NHIRD). Women who received primary and repeat surgeries, either hysteropexy or hysterectomy, were identified between 1997 and 2010; and followed up to 2010 or till the event of reoperation. We analyzed the variables including the primary surgical type, concomitant stress urinary incontinence (SUI) surgery, patient age, surgeon age, and hospital accreditation level. Results: Among the total 36,609 women, a higher reoperation rate was noted in the hysteropexy group (156/4095) (3.81%) than in the hysterectomy group (116/32,514) (0.36%); the adjusted odds ratio (OR) was 11.70 [95% confidence interval (CI): 8.86e15.43]. It was lower in patients with concomitant SUI surgery; older patients (aged 60 years and 40e69 years vs. < 40 years); older surgeons (aged 50 years and 40e49 years vs. < 40 years), but not significant in hospital levels. Hysterectomy was the preferred choice as compared with repeat hysteropexy (69.87% vs. 30.13%) among the failed hysteropexy group. All variables for the choice of repeat hysteropexy were not significant. Conclusion: Our study offers a population-based nationwide observation that hysteropexy correlates with a higher reoperation rate, as compared with hysterectomy; but it is still as high as 30% in the surgical choice of the failed hysteropexy group.

The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery

“…Even in the patients who needed reoperation after primary POP surgeries, their tendency of choosing hystero-preservation surgery was still high (30%). [ 8 ]…”

Episiotomy: the biomechanical impact of multiple small incisions during a normal vaginal delivery

“…According to Wu et al [3], the number of women with PFD will be 50% higher in 2050, compared to 2010 [3]. Consequently, corrective surgeries are expected to continue to increase, with a reoperation rate of 30% [4]. Therefore, to avoid perineal lacerations and future disorders, clinicians have recommended routine use of episiotomy for vaginal birth, which is a surgical cut of the vagina and perineum to enlarge the birth canal; however, this intervention guarantees perineal trauma and sutures.…”