Peri- and Postoperative Complications in Abdominal, Vaginal Extraperitoneal and Vaginal Intraperitoneal Colpopexy

Thursday, September 26, 2024

3:30 PM – 3:40 PM East Coast USA Time

Location: Mediterranean Salon 3, Lobby Level

Primary Presenter(s)

Kimberly C. Toumazos, M.S., Student Doctor (she/her/hers)

Medical Student
University of the Incarnate Word

Slides

Disclosure(s):

Kimberly C. Toumazos, M.S., Student Doctor: No financial relationships to disclose

Introduction/Purpose: Pelvic organ prolapse (POP) manifests with an incidence of 40% among the female demographic. A consequential subset of 7-9% of afflicted women necessitate surgical intervention including sacral colpopexy. There are multiple surgical approaches including vaginal, extraperitoneal, and intraperitoneal. This study aims to identify predictors of the outcomes with the different surgical approaches.

Methods or Case Description: This retrospective study utilized data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) gynecologic specific database for those that underwent sacral colpopexy for POP. The group was subdivided into their surgical approaches that included abdominal, vaginal extraperitoneal, and vaginal intraperitoneal. ANOVA analysis was performed between the three groups and a multivariate logistic regression was performed to determine the 30-day complication rate.

Outcomes: Among the 1,275 cases analyzed, 326 (25.6%) utilized an abdominal approach, 425 (33.3%) utilized a vaginal approach, and 524 (41.1%) utilized an extraperitoneal approach. The mean age was significantly higher for patients undergoing a vaginal extraperitoneal (64.5 years) compared to abdominal (62.1 years), and vaginal intraperitoneal (61.6 years). There was no difference in 30-day complication rate between the surgical approaches on adjusted analysis (Table), however vaginal extraperitoneal approach had the longest hospital stay, days from operation to discharge, and total operation time (Figure).

Table. Logistic Regression Model for 30-day Complication Following Colpopexy

Figure. Length of Operation Time, Hospital Stay, and Operation to Discharge for Different Surgical Approaches

Conclusion: Variety of surgical approaches for sacral colpopexy can be employed. In our study, we show that the 30-day complication rate was similar between the three approaches, however the length of hospital stay and operation time was the longest with vaginal extraperitoneal approach and shortest with the abdominal approach.
Learning Objectives:
Identify predictors of the outcomes in colpopexy with different surgical approaches.
Compare 30-day complication rates between abdominal, vaginal extraperitoneal and vaginal intraperitoneal approaches to colpopexy.
Explain the incidence of pelvic organ prolapse in the female population and the proportion of cases requiring surgical intervention.
Describe the different surgical approaches for sacral colpopexy, including abdominal, vaginal extraperitoneal, and vaginal intraperitoneal techniques.
Compare and contrast the length of hospital stay, days from operation to discharge, and total operation time for the different surgical techniques, with special attention to the vaginal extraperitoneal approach.