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.