Society of Gynecologic Surgeons (SGS): Annual Scientific Meeting

BALTIMORE – Obstetrician/gynecologists frequently use mesh kits for pelvic organ prolapse repair, although a considerable number do not routinely perform cystoscopy after prolapse repair, a survey of 261 physicians has shown.

In the study, almost three-quarters (72%) of the 261 respondents reported using anterior, posterior, or total mesh kits, reported Dr. Maria Estanol, who is a second-year fellow in female pelvic medicine and reconstructive surgery at Good Samaritan Hospital in Cincinnati.

After performing a retropubic midurethral sling, 95% reported performing cystoscopy. However, the numbers declined with other procedures: 82% performed cystoscopy after placing a transobturator midurethral sling; 81%, after placing a retropubic pubovaginal sling; and 74%, after doing a Burch bladder neck suspension. Only 46% reported performing cystoscopy after doing a uterosacral ligament suspension; 29%, after McCall’s culdoplasty; and 34%, after an anterior repair.

These were the findings from a cross-sectional survey of a random sample of 3,225 ob.gyns. The researchers used the American Medical Association’s physician database to identify potential participants. The sample was equally distributed for sex, geographical location of practice, and age group. Subspecialists were excluded. The researchers asked participants to answer a 32-item, Internet-based questionnaire about the management of stress urinary incontinence and pelvic organ prolapse (POP), Dr. Estanol reported at the annual meeting of the Society of Gynecologic Surgeons.

A total of 261 physicians responded (8% response rate). Roughly one-third of participants were between 41 and 60 years of age. The remaining two-thirds were 31-40 years of age or older than 60 years. Almost half (45%) of the physicians had been in practice more than 20 years. About two-thirds were male, and approximately two-thirds were in private practice.

Of the respondents, 54% reported performing urodynamics in their practice, and 57% reported doing residency training in urodynamics. Most (81%) reported performing surgery for stress incontinence. Three-quarters had performed transobturator midurethral sling procedures, 73% had performed retropubic midurethral sling procedures, and 69% had performed Burch bladder neck suspension procedures as treatments for stress urinary incontinence.

Almost all (99%) reported managing POP (surgical or medical), and 88% reported performing surgery for POP. Ninety-three percent reported doing residency surgical training for prolapse.

The meeting was jointly sponsored by the American College of Surgeons.

Dr. Estanol and her associates reported that they had no relevant financial disclosures.

BALTIMORE – Obstetrician/gynecologists frequently use mesh kits for pelvic organ prolapse repair, although a considerable number do not routinely perform cystoscopy after prolapse repair, a survey of 261 physicians has shown.

In the study, almost three-quarters (72%) of the 261 respondents reported using anterior, posterior, or total mesh kits, reported Dr. Maria Estanol, who is a second-year fellow in female pelvic medicine and reconstructive surgery at Good Samaritan Hospital in Cincinnati.

After performing a retropubic midurethral sling, 95% reported performing cystoscopy. However, the numbers declined with other procedures: 82% performed cystoscopy after placing a transobturator midurethral sling; 81%, after placing a retropubic pubovaginal sling; and 74%, after doing a Burch bladder neck suspension. Only 46% reported performing cystoscopy after doing a uterosacral ligament suspension; 29%, after McCall’s culdoplasty; and 34%, after an anterior repair.

These were the findings from a cross-sectional survey of a random sample of 3,225 ob.gyns. The researchers used the American Medical Association’s physician database to identify potential participants. The sample was equally distributed for sex, geographical location of practice, and age group. Subspecialists were excluded. The researchers asked participants to answer a 32-item, Internet-based questionnaire about the management of stress urinary incontinence and pelvic organ prolapse (POP), Dr. Estanol reported at the annual meeting of the Society of Gynecologic Surgeons.

A total of 261 physicians responded (8% response rate). Roughly one-third of participants were between 41 and 60 years of age. The remaining two-thirds were 31-40 years of age or older than 60 years. Almost half (45%) of the physicians had been in practice more than 20 years. About two-thirds were male, and approximately two-thirds were in private practice.

Of the respondents, 54% reported performing urodynamics in their practice, and 57% reported doing residency training in urodynamics. Most (81%) reported performing surgery for stress incontinence. Three-quarters had performed transobturator midurethral sling procedures, 73% had performed retropubic midurethral sling procedures, and 69% had performed Burch bladder neck suspension procedures as treatments for stress urinary incontinence.

Almost all (99%) reported managing POP (surgical or medical), and 88% reported performing surgery for POP. Ninety-three percent reported doing residency surgical training for prolapse.

The meeting was jointly sponsored by the American College of Surgeons.

Dr. Estanol and her associates reported that they had no relevant financial disclosures.

BALTIMORE – Obstetrician/gynecologists frequently use mesh kits for pelvic organ prolapse repair, although a considerable number do not routinely perform cystoscopy after prolapse repair, a survey of 261 physicians has shown.

In the study, almost three-quarters (72%) of the 261 respondents reported using anterior, posterior, or total mesh kits, reported Dr. Maria Estanol, who is a second-year fellow in female pelvic medicine and reconstructive surgery at Good Samaritan Hospital in Cincinnati.

After performing a retropubic midurethral sling, 95% reported performing cystoscopy. However, the numbers declined with other procedures: 82% performed cystoscopy after placing a transobturator midurethral sling; 81%, after placing a retropubic pubovaginal sling; and 74%, after doing a Burch bladder neck suspension. Only 46% reported performing cystoscopy after doing a uterosacral ligament suspension; 29%, after McCall’s culdoplasty; and 34%, after an anterior repair.

These were the findings from a cross-sectional survey of a random sample of 3,225 ob.gyns. The researchers used the American Medical Association’s physician database to identify potential participants. The sample was equally distributed for sex, geographical location of practice, and age group. Subspecialists were excluded. The researchers asked participants to answer a 32-item, Internet-based questionnaire about the management of stress urinary incontinence and pelvic organ prolapse (POP), Dr. Estanol reported at the annual meeting of the Society of Gynecologic Surgeons.

A total of 261 physicians responded (8% response rate). Roughly one-third of participants were between 41 and 60 years of age. The remaining two-thirds were 31-40 years of age or older than 60 years. Almost half (45%) of the physicians had been in practice more than 20 years. About two-thirds were male, and approximately two-thirds were in private practice.

Of the respondents, 54% reported performing urodynamics in their practice, and 57% reported doing residency training in urodynamics. Most (81%) reported performing surgery for stress incontinence. Three-quarters had performed transobturator midurethral sling procedures, 73% had performed retropubic midurethral sling procedures, and 69% had performed Burch bladder neck suspension procedures as treatments for stress urinary incontinence.

Almost all (99%) reported managing POP (surgical or medical), and 88% reported performing surgery for POP. Ninety-three percent reported doing residency surgical training for prolapse.

The meeting was jointly sponsored by the American College of Surgeons.

Dr. Estanol and her associates reported that they had no relevant financial disclosures.

BALTIMORE – Robotic procedures compare favorably with vaginal apical prolapse repair in elderly women, for whom pelvic organ prolapse repair is the most common gynecologic procedure.

In a retrospective study of 136 patients, estimated blood loss and need for postoperative transfusion were significantly lower in the robotic surgery group. Estimated blood loss was 91 mL in the robotic surgery group, compared with 172 mL in the vaginal surgery group. No patients needed postoperative transfusion in the robotic group, compared with 10 patients in the vaginal group, reported Dr. Barbara L. Robinson at the annual meeting of the Society of Gynecologic Surgeons.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair."

Total operative and total anesthesia times were significantly lower in the vaginal surgery group. Total operative time was 139 minutes for the vaginal surgery group, compared with 201 minutes in the robotic surgery group; total anesthesia time was 168 and 237 minutes in the vaginal and robotic groups, respectively.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair," said Dr. Robinson of the department of obstetrics and gynecology, University of North Carolina at Chapel Hill.

The researchers conducted a chart review of women aged 65 years and older who underwent robotic or vaginal apical support surgery (including colpocleisis) between March 2006 and April 2011. Patients were excluded if they had undergone a primary abdominal or laparoscopic apical support procedure for malignancy.

Preoperative risks were assessed using the American Society of Anesthesiologists (ASA) physical classification system and the Charlson Comorbidity Index (CCI). The CCI predicts 10-year mortality risk based on age and comorbidities. The ASA physical classification system is used to assess patient fitness prior to surgery. The researchers sought to determine if these measures of preoperative risk can predict risk in this population, and to characterize complications during apical support procedures using the Dindo classification of surgical complications. The Dindo system is used to grade and define perioperative complications. This system has five grades; a greater grade is associated with more severe complications. Cases were reviewed for surgical complications up to 12 months after surgery, and a Dindo grade was assigned accordingly.

Dr. Robinson and her colleagues identified a total of 136 patients – 70 had robotic surgery and 66 had vaginal surgery. The average age was 72 years, although patients in the vaginal surgery group were significantly older (74 vs. 70 years). The two groups did not significantly differ by body mass index, parity, or smoking status. The average apical prolapse stage was significantly lower in women who had vaginal surgery compared with robotic surgery – 1.6 vs. 2.1.

In the robotic surgery group, sacrocolpopexy was the most common procedure. In the vaginal group, uterine sacral ligament suspension and colpocleisis were the two most common procedures. Length of hospital stay was significantly longer for the vaginal surgery group than the robotic group – 2.2 vs. 2.0 days, respectively.

The most common preoperative comorbidities were hypertension, coronary artery disease, and diabetes. These morbidities were not significantly different between the two groups. However, history of a myocardial infarction was significantly lower in patients who had robotic surgery than in the vaginal surgery group (9% vs. 21%), as was the presence of dementia (0% vs. 9%).

"The [overall] study population was generally healthy, with a low mean CCI of 0.97. However, the vaginal surgery group had more severe comorbidities than the robotic surgery group based on the CCI," said Dr. Robinson. In contrast, based on ASA class, comorbidity was similar for the two groups. The most commonly assigned ASA classes were 2 and 3. No patients were assigned as class 5 or 6.

There were no significant differences in overall intraoperative complications, including cystotomy, trocar injury to the bladder, ureteral injury, bowel injury, or intraoperative transfusion. However, there were significantly fewer urinary tract infections – 6% vs. 18% – in the robotic surgery group following the procedure, she said at the meeting, which was jointly sponsored by the American College of Surgeons.

Overall, the majority of procedures – both robotic (67%) and vaginal (56%) – were associated with no complications based on Dindo class, she said. No patients were classified as grade IV or V. The Dindo classification was similar between the two groups.

"Neither the ASA or CCI correlated significantly with the Dindo grade," he said. Given the lack of correlation with the Dindo classification, ASA and CCI may have limited utility in elderly women undergoing pelvic floor reconstruction.

The authors reported that they had no relevant financial disclosures.

BALTIMORE – Robotic procedures compare favorably with vaginal apical prolapse repair in elderly women, for whom pelvic organ prolapse repair is the most common gynecologic procedure.

In a retrospective study of 136 patients, estimated blood loss and need for postoperative transfusion were significantly lower in the robotic surgery group. Estimated blood loss was 91 mL in the robotic surgery group, compared with 172 mL in the vaginal surgery group. No patients needed postoperative transfusion in the robotic group, compared with 10 patients in the vaginal group, reported Dr. Barbara L. Robinson at the annual meeting of the Society of Gynecologic Surgeons.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair."

Total operative and total anesthesia times were significantly lower in the vaginal surgery group. Total operative time was 139 minutes for the vaginal surgery group, compared with 201 minutes in the robotic surgery group; total anesthesia time was 168 and 237 minutes in the vaginal and robotic groups, respectively.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair," said Dr. Robinson of the department of obstetrics and gynecology, University of North Carolina at Chapel Hill.

The researchers conducted a chart review of women aged 65 years and older who underwent robotic or vaginal apical support surgery (including colpocleisis) between March 2006 and April 2011. Patients were excluded if they had undergone a primary abdominal or laparoscopic apical support procedure for malignancy.

Preoperative risks were assessed using the American Society of Anesthesiologists (ASA) physical classification system and the Charlson Comorbidity Index (CCI). The CCI predicts 10-year mortality risk based on age and comorbidities. The ASA physical classification system is used to assess patient fitness prior to surgery. The researchers sought to determine if these measures of preoperative risk can predict risk in this population, and to characterize complications during apical support procedures using the Dindo classification of surgical complications. The Dindo system is used to grade and define perioperative complications. This system has five grades; a greater grade is associated with more severe complications. Cases were reviewed for surgical complications up to 12 months after surgery, and a Dindo grade was assigned accordingly.

Dr. Robinson and her colleagues identified a total of 136 patients – 70 had robotic surgery and 66 had vaginal surgery. The average age was 72 years, although patients in the vaginal surgery group were significantly older (74 vs. 70 years). The two groups did not significantly differ by body mass index, parity, or smoking status. The average apical prolapse stage was significantly lower in women who had vaginal surgery compared with robotic surgery – 1.6 vs. 2.1.

In the robotic surgery group, sacrocolpopexy was the most common procedure. In the vaginal group, uterine sacral ligament suspension and colpocleisis were the two most common procedures. Length of hospital stay was significantly longer for the vaginal surgery group than the robotic group – 2.2 vs. 2.0 days, respectively.

The most common preoperative comorbidities were hypertension, coronary artery disease, and diabetes. These morbidities were not significantly different between the two groups. However, history of a myocardial infarction was significantly lower in patients who had robotic surgery than in the vaginal surgery group (9% vs. 21%), as was the presence of dementia (0% vs. 9%).

"The [overall] study population was generally healthy, with a low mean CCI of 0.97. However, the vaginal surgery group had more severe comorbidities than the robotic surgery group based on the CCI," said Dr. Robinson. In contrast, based on ASA class, comorbidity was similar for the two groups. The most commonly assigned ASA classes were 2 and 3. No patients were assigned as class 5 or 6.

There were no significant differences in overall intraoperative complications, including cystotomy, trocar injury to the bladder, ureteral injury, bowel injury, or intraoperative transfusion. However, there were significantly fewer urinary tract infections – 6% vs. 18% – in the robotic surgery group following the procedure, she said at the meeting, which was jointly sponsored by the American College of Surgeons.

Overall, the majority of procedures – both robotic (67%) and vaginal (56%) – were associated with no complications based on Dindo class, she said. No patients were classified as grade IV or V. The Dindo classification was similar between the two groups.

"Neither the ASA or CCI correlated significantly with the Dindo grade," he said. Given the lack of correlation with the Dindo classification, ASA and CCI may have limited utility in elderly women undergoing pelvic floor reconstruction.

The authors reported that they had no relevant financial disclosures.

BALTIMORE – Robotic procedures compare favorably with vaginal apical prolapse repair in elderly women, for whom pelvic organ prolapse repair is the most common gynecologic procedure.

In a retrospective study of 136 patients, estimated blood loss and need for postoperative transfusion were significantly lower in the robotic surgery group. Estimated blood loss was 91 mL in the robotic surgery group, compared with 172 mL in the vaginal surgery group. No patients needed postoperative transfusion in the robotic group, compared with 10 patients in the vaginal group, reported Dr. Barbara L. Robinson at the annual meeting of the Society of Gynecologic Surgeons.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair."

Total operative and total anesthesia times were significantly lower in the vaginal surgery group. Total operative time was 139 minutes for the vaginal surgery group, compared with 201 minutes in the robotic surgery group; total anesthesia time was 168 and 237 minutes in the vaginal and robotic groups, respectively.

"We demonstrate low rates of perioperative morbidity in elderly women undergoing both robotic and vaginal reconstructive procedures for apical prolapse repair," said Dr. Robinson of the department of obstetrics and gynecology, University of North Carolina at Chapel Hill.

The researchers conducted a chart review of women aged 65 years and older who underwent robotic or vaginal apical support surgery (including colpocleisis) between March 2006 and April 2011. Patients were excluded if they had undergone a primary abdominal or laparoscopic apical support procedure for malignancy.

Preoperative risks were assessed using the American Society of Anesthesiologists (ASA) physical classification system and the Charlson Comorbidity Index (CCI). The CCI predicts 10-year mortality risk based on age and comorbidities. The ASA physical classification system is used to assess patient fitness prior to surgery. The researchers sought to determine if these measures of preoperative risk can predict risk in this population, and to characterize complications during apical support procedures using the Dindo classification of surgical complications. The Dindo system is used to grade and define perioperative complications. This system has five grades; a greater grade is associated with more severe complications. Cases were reviewed for surgical complications up to 12 months after surgery, and a Dindo grade was assigned accordingly.

Dr. Robinson and her colleagues identified a total of 136 patients – 70 had robotic surgery and 66 had vaginal surgery. The average age was 72 years, although patients in the vaginal surgery group were significantly older (74 vs. 70 years). The two groups did not significantly differ by body mass index, parity, or smoking status. The average apical prolapse stage was significantly lower in women who had vaginal surgery compared with robotic surgery – 1.6 vs. 2.1.

In the robotic surgery group, sacrocolpopexy was the most common procedure. In the vaginal group, uterine sacral ligament suspension and colpocleisis were the two most common procedures. Length of hospital stay was significantly longer for the vaginal surgery group than the robotic group – 2.2 vs. 2.0 days, respectively.

The most common preoperative comorbidities were hypertension, coronary artery disease, and diabetes. These morbidities were not significantly different between the two groups. However, history of a myocardial infarction was significantly lower in patients who had robotic surgery than in the vaginal surgery group (9% vs. 21%), as was the presence of dementia (0% vs. 9%).

"The [overall] study population was generally healthy, with a low mean CCI of 0.97. However, the vaginal surgery group had more severe comorbidities than the robotic surgery group based on the CCI," said Dr. Robinson. In contrast, based on ASA class, comorbidity was similar for the two groups. The most commonly assigned ASA classes were 2 and 3. No patients were assigned as class 5 or 6.

There were no significant differences in overall intraoperative complications, including cystotomy, trocar injury to the bladder, ureteral injury, bowel injury, or intraoperative transfusion. However, there were significantly fewer urinary tract infections – 6% vs. 18% – in the robotic surgery group following the procedure, she said at the meeting, which was jointly sponsored by the American College of Surgeons.

Overall, the majority of procedures – both robotic (67%) and vaginal (56%) – were associated with no complications based on Dindo class, she said. No patients were classified as grade IV or V. The Dindo classification was similar between the two groups.

"Neither the ASA or CCI correlated significantly with the Dindo grade," he said. Given the lack of correlation with the Dindo classification, ASA and CCI may have limited utility in elderly women undergoing pelvic floor reconstruction.

The authors reported that they had no relevant financial disclosures.

BALTIMORE – Gastrointestinal complication rates from laparoscopic sacrocolpopexy are low, although a significant portion of these complications require readmissions and reoperations, based on the results of a retrospective analysis of 390 patients.

Functional GI complications occurred in 1.8% of patients, and bowel injury occurred in 1.3% of patients. Of the seven patients with functional GI complications, four were related to the ileus/small-bowel obstruction and three had nausea and vomiting. Of the five bowel injuries, three were small-bowel injuries and two were rectal injuries, Dr. William B. Warner reported at the annual meeting of the Society of Gynecologic Surgeons.

The researchers conducted a retrospective cohort study of patients at Inova Fairfax Hospital in Falls Church, Va., who underwent a laparoscopic sacrocolpopexy between January 2006 and August 2010. They collected demographic information, operative details, and data on intraoperative and postoperative complications.

The study included 390 patients who had a mean age of 59 years, a mean body mass index of 27, and a median follow-up of 6 months. The mean hospital stay was 1.7 days, with 93% leaving on postoperative days 1 (44%) or 2 (49%). Almost three-quarters (72%) of patients had a concurrent hysterectomy.

The researchers divided GI complications into two groups: functional complications (nausea/emesis, ileus and small-bowel obstruction) and bowel injury (injury to either the small bowel or rectum). A complication was considered to be functional if it involved prolonged admission (greater than 48 hours), readmission, or reoperation.

There were seven functional GI complications, four of which involved ileus/small-bowel obstruction (four readmissions and one reoperation), and three cases of nausea and vomiting (two that required prolonged stay and one that required readmission). There were also five cases of bowel injury (1.3%), three of which involved the small bowel (one that was recognized and repaired intraoperatively, and two that were unrecognized, resulting in reoperation and lengthy readmission), and two rectal injuries (one that was repaired intraoperatively and one rectovaginal fistula).

"We attempted to find risk factors for the most common complications," said Dr. Warner, who is an urogynecology fellow at the Walter Reed National Military Medical Center in Bethesda, Md.

They found that all patients with functional GI complications had prior abdominal surgery. "This association with prior abdominal surgery was statistically significant. Interestingly, bowel injury was not associated with prior abdominal surgery," he said at the meeting, which was jointly sponsored by the American College of Surgeons. Neither functional GI complications nor bowel injury was associated with age, body mass index, estimated blood loss, or operating room time.

Most patients used oral sodium for bowel preparation. Only polypropylene mesh was used, and the peritoneum was closed over the mesh in almost all cases. Patients were given a clear liquid diet immediately after surgery and were started on regular food the following morning. The aim was to discharge patients on the first postoperative day.

The authors reported that they have no relevant financial disclosures.

BALTIMORE – Gastrointestinal complication rates from laparoscopic sacrocolpopexy are low, although a significant portion of these complications require readmissions and reoperations, based on the results of a retrospective analysis of 390 patients.

Functional GI complications occurred in 1.8% of patients, and bowel injury occurred in 1.3% of patients. Of the seven patients with functional GI complications, four were related to the ileus/small-bowel obstruction and three had nausea and vomiting. Of the five bowel injuries, three were small-bowel injuries and two were rectal injuries, Dr. William B. Warner reported at the annual meeting of the Society of Gynecologic Surgeons.

The researchers conducted a retrospective cohort study of patients at Inova Fairfax Hospital in Falls Church, Va., who underwent a laparoscopic sacrocolpopexy between January 2006 and August 2010. They collected demographic information, operative details, and data on intraoperative and postoperative complications.

The study included 390 patients who had a mean age of 59 years, a mean body mass index of 27, and a median follow-up of 6 months. The mean hospital stay was 1.7 days, with 93% leaving on postoperative days 1 (44%) or 2 (49%). Almost three-quarters (72%) of patients had a concurrent hysterectomy.

The researchers divided GI complications into two groups: functional complications (nausea/emesis, ileus and small-bowel obstruction) and bowel injury (injury to either the small bowel or rectum). A complication was considered to be functional if it involved prolonged admission (greater than 48 hours), readmission, or reoperation.

There were seven functional GI complications, four of which involved ileus/small-bowel obstruction (four readmissions and one reoperation), and three cases of nausea and vomiting (two that required prolonged stay and one that required readmission). There were also five cases of bowel injury (1.3%), three of which involved the small bowel (one that was recognized and repaired intraoperatively, and two that were unrecognized, resulting in reoperation and lengthy readmission), and two rectal injuries (one that was repaired intraoperatively and one rectovaginal fistula).

"We attempted to find risk factors for the most common complications," said Dr. Warner, who is an urogynecology fellow at the Walter Reed National Military Medical Center in Bethesda, Md.

They found that all patients with functional GI complications had prior abdominal surgery. "This association with prior abdominal surgery was statistically significant. Interestingly, bowel injury was not associated with prior abdominal surgery," he said at the meeting, which was jointly sponsored by the American College of Surgeons. Neither functional GI complications nor bowel injury was associated with age, body mass index, estimated blood loss, or operating room time.

Most patients used oral sodium for bowel preparation. Only polypropylene mesh was used, and the peritoneum was closed over the mesh in almost all cases. Patients were given a clear liquid diet immediately after surgery and were started on regular food the following morning. The aim was to discharge patients on the first postoperative day.

The authors reported that they have no relevant financial disclosures.

BALTIMORE – Gastrointestinal complication rates from laparoscopic sacrocolpopexy are low, although a significant portion of these complications require readmissions and reoperations, based on the results of a retrospective analysis of 390 patients.

Functional GI complications occurred in 1.8% of patients, and bowel injury occurred in 1.3% of patients. Of the seven patients with functional GI complications, four were related to the ileus/small-bowel obstruction and three had nausea and vomiting. Of the five bowel injuries, three were small-bowel injuries and two were rectal injuries, Dr. William B. Warner reported at the annual meeting of the Society of Gynecologic Surgeons.

The researchers conducted a retrospective cohort study of patients at Inova Fairfax Hospital in Falls Church, Va., who underwent a laparoscopic sacrocolpopexy between January 2006 and August 2010. They collected demographic information, operative details, and data on intraoperative and postoperative complications.

The study included 390 patients who had a mean age of 59 years, a mean body mass index of 27, and a median follow-up of 6 months. The mean hospital stay was 1.7 days, with 93% leaving on postoperative days 1 (44%) or 2 (49%). Almost three-quarters (72%) of patients had a concurrent hysterectomy.

The researchers divided GI complications into two groups: functional complications (nausea/emesis, ileus and small-bowel obstruction) and bowel injury (injury to either the small bowel or rectum). A complication was considered to be functional if it involved prolonged admission (greater than 48 hours), readmission, or reoperation.

There were seven functional GI complications, four of which involved ileus/small-bowel obstruction (four readmissions and one reoperation), and three cases of nausea and vomiting (two that required prolonged stay and one that required readmission). There were also five cases of bowel injury (1.3%), three of which involved the small bowel (one that was recognized and repaired intraoperatively, and two that were unrecognized, resulting in reoperation and lengthy readmission), and two rectal injuries (one that was repaired intraoperatively and one rectovaginal fistula).

"We attempted to find risk factors for the most common complications," said Dr. Warner, who is an urogynecology fellow at the Walter Reed National Military Medical Center in Bethesda, Md.

They found that all patients with functional GI complications had prior abdominal surgery. "This association with prior abdominal surgery was statistically significant. Interestingly, bowel injury was not associated with prior abdominal surgery," he said at the meeting, which was jointly sponsored by the American College of Surgeons. Neither functional GI complications nor bowel injury was associated with age, body mass index, estimated blood loss, or operating room time.

Most patients used oral sodium for bowel preparation. Only polypropylene mesh was used, and the peritoneum was closed over the mesh in almost all cases. Patients were given a clear liquid diet immediately after surgery and were started on regular food the following morning. The aim was to discharge patients on the first postoperative day.

The authors reported that they have no relevant financial disclosures.

BALTIMORE – Concomitant hysterectomy increases the risk of mesh extrusion in pelvic reconstructive surgery by more than fivefold, according to the results of a retrospective case-control study of women undergoing abdominal sacral colpopexy or vaginal mesh procedures.

"This is a very timely and important research topic, especially given the recent [Food and Drug Administration] advisory," said Dr. Nazanin Ehsani, who presented the results at the annual meeting of the Society of Gynecologic Surgeons.

In 2008 and again in 2011, the FDA issued warnings about the use of transvaginal mesh. The 2011 warning was issued to inform health care professionals that serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse (POP) are not rare. The agency also noted that it is not clear that transvaginal repair with mesh is more effective than traditional non-mesh repair in all patients with POP, and it may expose patients to greater risk.

On multivariate analysis, concomitant hysterectomy was associated with an increased risk of mesh extrusion compared with no hysterectomy (odds ratio, 5.97; P = .003). Previous hysterectomy showed a trend toward increased risk of mesh extrusion compared with no hysterectomy (OR, 2.63; P = .06). In addition, concomitant hysterectomy was significantly associated with increased risk of mesh extrusion compared with previous hysterectomy (OR, 2.27; P =.03), Dr. Ehsani said at the meeting, which was jointly sponsored by the American College of Surgeons.

The researchers conducted a case-control study of women who underwent an abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP) and developed mesh extrusion. Cases were matched with controls in a ratio of 1:3 by procedure data and type. Cases and controls were identified using diagnosis and procedure codes. Cases and control patients underwent the procedures between January 2006 and December 2009. The researchers collected information on age, race, type of procedure, estrogen status, hysterectomy status, type of vaginal incision, comorbidities, and smoking history.

They identified 84 case patients – 43 who underwent an ASC and 41 who underwent a VMP – and 314 controls. The mean age of the entire patient population was 62 years, with a median body mass index of 27.1 kg/m². The median time to the diagnosis of mesh extrusion was 16 weeks. Patients with ASCs were significantly younger than women in the other groups; patients in the ASC and control groups were significantly less likely to be smokers.

Mesh extrusion occurred most commonly in the anterior compartment (44%) in women who had a VMP, followed by the apical compartment (34%) and the posterior compartment (22%). Among women who had an ASC, extrusion occurred most commonly in the posterior compartment (63%), and occurred in the anterior compartment in 7% and in the apical compartment in 7%. Compartment status was unknown for 23% of women who had an ASC.

Concomitant hysterectomy is a significant risk factor for mesh extrusion in pelvic reconstructive surgery. "If a hysterectomy is indicated at the time of prolapse surgery, different approaches should be considered. When performing an abdominal sacral colpopexy, surgeons may want to consider a supracervical approach. This must be weighed against the risks of cervical preservation, including future cervical pathology and bleeding, as well as patient desires," said Dr. Ehsani of the department of obstetrics and gynecology at St. Luke’s Hospital in Bethlehem, Pa. "In the case of vaginal mesh procedure, surgeons may want to consider making separate vaginal incisions for mesh placement – that do not connect the vaginal cuff incision."

Dr. Ehsani reported that she is a consultant for American Medical Systems. Two of her coauthors are also consultants for American Medical Systems and Ethicon.

BALTIMORE – Concomitant hysterectomy increases the risk of mesh extrusion in pelvic reconstructive surgery by more than fivefold, according to the results of a retrospective case-control study of women undergoing abdominal sacral colpopexy or vaginal mesh procedures.

"This is a very timely and important research topic, especially given the recent [Food and Drug Administration] advisory," said Dr. Nazanin Ehsani, who presented the results at the annual meeting of the Society of Gynecologic Surgeons.

In 2008 and again in 2011, the FDA issued warnings about the use of transvaginal mesh. The 2011 warning was issued to inform health care professionals that serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse (POP) are not rare. The agency also noted that it is not clear that transvaginal repair with mesh is more effective than traditional non-mesh repair in all patients with POP, and it may expose patients to greater risk.

On multivariate analysis, concomitant hysterectomy was associated with an increased risk of mesh extrusion compared with no hysterectomy (odds ratio, 5.97; P = .003). Previous hysterectomy showed a trend toward increased risk of mesh extrusion compared with no hysterectomy (OR, 2.63; P = .06). In addition, concomitant hysterectomy was significantly associated with increased risk of mesh extrusion compared with previous hysterectomy (OR, 2.27; P =.03), Dr. Ehsani said at the meeting, which was jointly sponsored by the American College of Surgeons.

The researchers conducted a case-control study of women who underwent an abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP) and developed mesh extrusion. Cases were matched with controls in a ratio of 1:3 by procedure data and type. Cases and controls were identified using diagnosis and procedure codes. Cases and control patients underwent the procedures between January 2006 and December 2009. The researchers collected information on age, race, type of procedure, estrogen status, hysterectomy status, type of vaginal incision, comorbidities, and smoking history.

They identified 84 case patients – 43 who underwent an ASC and 41 who underwent a VMP – and 314 controls. The mean age of the entire patient population was 62 years, with a median body mass index of 27.1 kg/m². The median time to the diagnosis of mesh extrusion was 16 weeks. Patients with ASCs were significantly younger than women in the other groups; patients in the ASC and control groups were significantly less likely to be smokers.

Mesh extrusion occurred most commonly in the anterior compartment (44%) in women who had a VMP, followed by the apical compartment (34%) and the posterior compartment (22%). Among women who had an ASC, extrusion occurred most commonly in the posterior compartment (63%), and occurred in the anterior compartment in 7% and in the apical compartment in 7%. Compartment status was unknown for 23% of women who had an ASC.

Concomitant hysterectomy is a significant risk factor for mesh extrusion in pelvic reconstructive surgery. "If a hysterectomy is indicated at the time of prolapse surgery, different approaches should be considered. When performing an abdominal sacral colpopexy, surgeons may want to consider a supracervical approach. This must be weighed against the risks of cervical preservation, including future cervical pathology and bleeding, as well as patient desires," said Dr. Ehsani of the department of obstetrics and gynecology at St. Luke’s Hospital in Bethlehem, Pa. "In the case of vaginal mesh procedure, surgeons may want to consider making separate vaginal incisions for mesh placement – that do not connect the vaginal cuff incision."

Dr. Ehsani reported that she is a consultant for American Medical Systems. Two of her coauthors are also consultants for American Medical Systems and Ethicon.

BALTIMORE – Concomitant hysterectomy increases the risk of mesh extrusion in pelvic reconstructive surgery by more than fivefold, according to the results of a retrospective case-control study of women undergoing abdominal sacral colpopexy or vaginal mesh procedures.

"This is a very timely and important research topic, especially given the recent [Food and Drug Administration] advisory," said Dr. Nazanin Ehsani, who presented the results at the annual meeting of the Society of Gynecologic Surgeons.

In 2008 and again in 2011, the FDA issued warnings about the use of transvaginal mesh. The 2011 warning was issued to inform health care professionals that serious complications associated with surgical mesh for transvaginal repair of pelvic organ prolapse (POP) are not rare. The agency also noted that it is not clear that transvaginal repair with mesh is more effective than traditional non-mesh repair in all patients with POP, and it may expose patients to greater risk.

On multivariate analysis, concomitant hysterectomy was associated with an increased risk of mesh extrusion compared with no hysterectomy (odds ratio, 5.97; P = .003). Previous hysterectomy showed a trend toward increased risk of mesh extrusion compared with no hysterectomy (OR, 2.63; P = .06). In addition, concomitant hysterectomy was significantly associated with increased risk of mesh extrusion compared with previous hysterectomy (OR, 2.27; P =.03), Dr. Ehsani said at the meeting, which was jointly sponsored by the American College of Surgeons.

The researchers conducted a case-control study of women who underwent an abdominal sacral colpopexy (ASC) or vaginal mesh procedure (VMP) and developed mesh extrusion. Cases were matched with controls in a ratio of 1:3 by procedure data and type. Cases and controls were identified using diagnosis and procedure codes. Cases and control patients underwent the procedures between January 2006 and December 2009. The researchers collected information on age, race, type of procedure, estrogen status, hysterectomy status, type of vaginal incision, comorbidities, and smoking history.

They identified 84 case patients – 43 who underwent an ASC and 41 who underwent a VMP – and 314 controls. The mean age of the entire patient population was 62 years, with a median body mass index of 27.1 kg/m². The median time to the diagnosis of mesh extrusion was 16 weeks. Patients with ASCs were significantly younger than women in the other groups; patients in the ASC and control groups were significantly less likely to be smokers.

Mesh extrusion occurred most commonly in the anterior compartment (44%) in women who had a VMP, followed by the apical compartment (34%) and the posterior compartment (22%). Among women who had an ASC, extrusion occurred most commonly in the posterior compartment (63%), and occurred in the anterior compartment in 7% and in the apical compartment in 7%. Compartment status was unknown for 23% of women who had an ASC.

Concomitant hysterectomy is a significant risk factor for mesh extrusion in pelvic reconstructive surgery. "If a hysterectomy is indicated at the time of prolapse surgery, different approaches should be considered. When performing an abdominal sacral colpopexy, surgeons may want to consider a supracervical approach. This must be weighed against the risks of cervical preservation, including future cervical pathology and bleeding, as well as patient desires," said Dr. Ehsani of the department of obstetrics and gynecology at St. Luke’s Hospital in Bethlehem, Pa. "In the case of vaginal mesh procedure, surgeons may want to consider making separate vaginal incisions for mesh placement – that do not connect the vaginal cuff incision."

Dr. Ehsani reported that she is a consultant for American Medical Systems. Two of her coauthors are also consultants for American Medical Systems and Ethicon.

BALTIMORE – Abdominal sacrocolpopexy is associated with a higher rate of peri- and postoperative complications, compared with minimally invasive sacrocolpopexy, based on the results of a review of 831 sacrocolpopexy procedures.

There were significantly more overall intra- and postoperative complications associated with abdominal sacrocolpopexy (ASC) than with minimally invasive sacrocolpopexy (MISC) – 17.2% vs. 10.1% respectively. In particular, there also were significantly more cystotomy complications (4.8% vs. 2.1%) and ileus/small bowel obstruction complications (4.8% vs. 1.8%) in the ASC group, Dr. Patrick A. Nosti reported at the annual meeting of the Society of Gynecologic Surgeons.

Sacrocolpopexy is the preferred surgical treatment for apical prolapse, with a success rate of more than 95%, but there have been a limited number of small prospective and retrospective studies comparing ASC and MISC, said Dr. Nosti, a fellow in the female pelvic medicine and reconstructive surgery fellowship program in the department of obstetrics and gynecology at Washington (D.C.) Hospital Center.

He and his associates conducted a multicenter, retrospective cohort study including cases from January 1999 to December 2010 at four sites. The study was conducted through the Fellows' Pelvic Research Network. The primary outcome was the sum of all intra- and immediate postoperative complications. Secondary outcomes included anatomic success (Pelvic Organ Prolapse Quantification system less than stage II), mesh erosions, estimated blood loss, operative time, and length of hospitalization.

The investigators included 831 sacrocolpopexy procedures; the demographic data was similar between the two groups. The overall mean age was 58 years, mean body mass index was 27.3, and mean parity was three. Of these, 400 patients underwent ASC and 431 underwent MISC. Of the MISC patients, 213 had laparoscopic procedures and 218 had robotic procedures.

There were significantly more anatomical failures (24% vs. 14%), greater estimated blood loss (188 mL vs. 122 mL), longer hospitalization (2.8 vs. 1.2 days), and increased OR time (234 minutes vs. 206) in the ASC group, compared with the MISC group, Dr. Nosti reported.

There were, however, significantly more mesh erosions (3.2% vs. 1%) in the MISC group, compared with the ASC group, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Mesh erosion was significantly more common after total vs. supracervical hysterectomy (4.2% vs. 0.8% respectively).

In terms of robotic sacrocolpopexy compared with laparoscopic sacrocolpopexy, there was no significant difference in complications (8% vs. 13%). There were fewer failures with robotic procedures than with laparoscopic procedures (6% vs. 19%), despite more advanced preoperative prolapse. In addition, OR time was longer with robotic procedures than with laparoscopic sacrocolpopexy (330 minutes vs. 268 minutes).

The researchers reported that they have no conflicts of interest.

BALTIMORE – Abdominal sacrocolpopexy is associated with a higher rate of peri- and postoperative complications, compared with minimally invasive sacrocolpopexy, based on the results of a review of 831 sacrocolpopexy procedures.

There were significantly more overall intra- and postoperative complications associated with abdominal sacrocolpopexy (ASC) than with minimally invasive sacrocolpopexy (MISC) – 17.2% vs. 10.1% respectively. In particular, there also were significantly more cystotomy complications (4.8% vs. 2.1%) and ileus/small bowel obstruction complications (4.8% vs. 1.8%) in the ASC group, Dr. Patrick A. Nosti reported at the annual meeting of the Society of Gynecologic Surgeons.

Sacrocolpopexy is the preferred surgical treatment for apical prolapse, with a success rate of more than 95%, but there have been a limited number of small prospective and retrospective studies comparing ASC and MISC, said Dr. Nosti, a fellow in the female pelvic medicine and reconstructive surgery fellowship program in the department of obstetrics and gynecology at Washington (D.C.) Hospital Center.

He and his associates conducted a multicenter, retrospective cohort study including cases from January 1999 to December 2010 at four sites. The study was conducted through the Fellows' Pelvic Research Network. The primary outcome was the sum of all intra- and immediate postoperative complications. Secondary outcomes included anatomic success (Pelvic Organ Prolapse Quantification system less than stage II), mesh erosions, estimated blood loss, operative time, and length of hospitalization.

The investigators included 831 sacrocolpopexy procedures; the demographic data was similar between the two groups. The overall mean age was 58 years, mean body mass index was 27.3, and mean parity was three. Of these, 400 patients underwent ASC and 431 underwent MISC. Of the MISC patients, 213 had laparoscopic procedures and 218 had robotic procedures.

There were significantly more anatomical failures (24% vs. 14%), greater estimated blood loss (188 mL vs. 122 mL), longer hospitalization (2.8 vs. 1.2 days), and increased OR time (234 minutes vs. 206) in the ASC group, compared with the MISC group, Dr. Nosti reported.

There were, however, significantly more mesh erosions (3.2% vs. 1%) in the MISC group, compared with the ASC group, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Mesh erosion was significantly more common after total vs. supracervical hysterectomy (4.2% vs. 0.8% respectively).

In terms of robotic sacrocolpopexy compared with laparoscopic sacrocolpopexy, there was no significant difference in complications (8% vs. 13%). There were fewer failures with robotic procedures than with laparoscopic procedures (6% vs. 19%), despite more advanced preoperative prolapse. In addition, OR time was longer with robotic procedures than with laparoscopic sacrocolpopexy (330 minutes vs. 268 minutes).

The researchers reported that they have no conflicts of interest.

BALTIMORE – Abdominal sacrocolpopexy is associated with a higher rate of peri- and postoperative complications, compared with minimally invasive sacrocolpopexy, based on the results of a review of 831 sacrocolpopexy procedures.

There were significantly more overall intra- and postoperative complications associated with abdominal sacrocolpopexy (ASC) than with minimally invasive sacrocolpopexy (MISC) – 17.2% vs. 10.1% respectively. In particular, there also were significantly more cystotomy complications (4.8% vs. 2.1%) and ileus/small bowel obstruction complications (4.8% vs. 1.8%) in the ASC group, Dr. Patrick A. Nosti reported at the annual meeting of the Society of Gynecologic Surgeons.

Sacrocolpopexy is the preferred surgical treatment for apical prolapse, with a success rate of more than 95%, but there have been a limited number of small prospective and retrospective studies comparing ASC and MISC, said Dr. Nosti, a fellow in the female pelvic medicine and reconstructive surgery fellowship program in the department of obstetrics and gynecology at Washington (D.C.) Hospital Center.

He and his associates conducted a multicenter, retrospective cohort study including cases from January 1999 to December 2010 at four sites. The study was conducted through the Fellows' Pelvic Research Network. The primary outcome was the sum of all intra- and immediate postoperative complications. Secondary outcomes included anatomic success (Pelvic Organ Prolapse Quantification system less than stage II), mesh erosions, estimated blood loss, operative time, and length of hospitalization.

The investigators included 831 sacrocolpopexy procedures; the demographic data was similar between the two groups. The overall mean age was 58 years, mean body mass index was 27.3, and mean parity was three. Of these, 400 patients underwent ASC and 431 underwent MISC. Of the MISC patients, 213 had laparoscopic procedures and 218 had robotic procedures.

There were significantly more anatomical failures (24% vs. 14%), greater estimated blood loss (188 mL vs. 122 mL), longer hospitalization (2.8 vs. 1.2 days), and increased OR time (234 minutes vs. 206) in the ASC group, compared with the MISC group, Dr. Nosti reported.

There were, however, significantly more mesh erosions (3.2% vs. 1%) in the MISC group, compared with the ASC group, he said at the meeting, which was jointly sponsored by the American College of Surgeons.

Mesh erosion was significantly more common after total vs. supracervical hysterectomy (4.2% vs. 0.8% respectively).

In terms of robotic sacrocolpopexy compared with laparoscopic sacrocolpopexy, there was no significant difference in complications (8% vs. 13%). There were fewer failures with robotic procedures than with laparoscopic procedures (6% vs. 19%), despite more advanced preoperative prolapse. In addition, OR time was longer with robotic procedures than with laparoscopic sacrocolpopexy (330 minutes vs. 268 minutes).

The researchers reported that they have no conflicts of interest.