PURPOSE: To systematically review surgical complications of vaginal native tissue prolapse repair using Clavien-Dindo classification and to show whether concomitant surgery leads to increased complication rates.
METHODS: Retrospective analysis of complications in 438 consecutive vaginal native tissue prolapse repairs and subgroup analysis was performed for concomitant hysterectomy or sacrospinous fixation for level I defects using Fisher´s exact tests.
RESULTS: Anterior and posterior colporrhaphia was performed in all 438 patients and sacrospinous fixation (SSF) for level I defects in 269 patients. Prolapse repair was combined with hysterectomy in 255 cases. One intra-operative bladder lesion (0.23 %) and one rectal lesion (0.23 %) occurred. Postoperative urinary tract infection requiring antibiotics was noted in 34 cases (7.8 %). Post-void residual volume was medically treated in 24 cases (5.5 %). Four patients (0.9 %) underwent postoperative suprapubic catheter insertion. Asymptomatic gluteal hematomas were noted in 11 cases (2.5 %). Four patients (0.9 %) underwent re-operations for postoperative hemorrhage. Mean hospital stay was 5.6 days. Minor complications were classified as CD grade I in 2.5 %, as CD grade II in 13.2 %, complications requiring surgical intervention as grade IIIa in 0.9 % and as grade IIIb in 0.9 % of patients. No CD grade IV or V complications occurred. Apart from gluteal hematomas classified as CD grade I occurring in the SSF group (p = 0.019), no other differences of complication rates were found in the hysterectomy subgroup or in the SSF subgroup.
CONCLUSION: Surgery was associated with low rate of CD grade III complications. Re-operation rate was 0.9 %. The authors suggest introduction of CD classification for comparability of prolapse surgery.
Written by:
Mothes AR, Mothes HK, Radosa MP, Runnebaum IB. Are you the author?
Department of Gynecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, 07743, Jena, Germany.
Reference: Arch Gynecol Obstet. 2014 Nov 28. Epub ahead of print.
doi: 10.1007/s00404-014-3549-1
PubMed Abstract
PMID: 25430736