Weinberg Daniel, Qeadan Fares, McKee Rohini, Rogers Rebecca G, Komesu Yuko M
Department of Obstetrics and Gynecology, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131, USA.
Department of Internal Medicine, University of New Mexico, MSC 10-5580, Albuquerque, NM, 87131, USA.
Int Urogynecol J. 2019 Mar;30(3):385-392. doi: 10.1007/s00192-018-3699-y. Epub 2018 Jul 3.
Rectopexy and sacrocolpopexy can be performed concurrently to treat rectal and vaginal prolapse. We hypothesized that concurrent procedures might be associated with more complications than rectopexy and sacrocolpopexy alone.
Patients undergoing laparoscopic sacrocolpopexy or rectopexy, or concurrent laparoscopic sacrocolpopexy and rectopexy were identified in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2013 to 2016. Preoperative characteristics, operative time, and 30-day post-operative complications were compared between groups. Complications were those defined by the ACS Risk Calculator. Descriptive tests and regression methods were utilized for group comparisons. Significance was set at p < 0.05.
We identified 7,232 laparoscopic sacrocolpopexy, 1,560 laparoscopic rectopexy, and 123 concurrent laparoscopic sacrocolpopexy and rectopexy cases. Patients undergoing concurrent procedures were more commonly white, non-Hispanic, non-diabetic, and smokers. Operative time was longest for concurrent procedures, followed by sacrocolpopexy and rectopexy (p < 0.0001). Patients undergoing isolated rectopexy were more commonly ≥ American Society of Anesthesiologists class 3 (p < 0.0001). Rates of any complication for colpopexy, rectopexy, and concurrent procedures did not differ (6.18%, 7.63%, 8.94%; p = 0.058). Serious complication rates for colpopexy, rectopexy, and concurrent procedures did not differ (5.52%, 6.35%, 8.13%; p = 0.222). Odds of experiencing any complication were higher comparing rectopexy with colpopexy alone (adjusted odds ratio = 1.252, 95% CI 1.002-1.565). Comparing all groups, rectopexy had the highest mortality, reoperation, and transfusion rates (all p < 0.05). Concurrent procedures had the highest surgical site and urinary tract infection rates (all p < 0.05).
Complications were low for all three procedures. Concurrent repair may be appropriate in well-selected patients.
直肠固定术和骶骨阴道固定术可同时进行以治疗直肠脱垂和阴道脱垂。我们假设与单独进行直肠固定术和骶骨阴道固定术相比，同时进行这两种手术可能会伴有更多并发症。
在2013年至2016年美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）数据库中，识别出接受腹腔镜骶骨阴道固定术、直肠固定术或同时接受腹腔镜骶骨阴道固定术和直肠固定术的患者。比较各组患者的术前特征、手术时间和术后30天并发症情况。并发症由ACS风险计算器定义。采用描述性检验和回归方法进行组间比较。显著性设定为p < 0.05。
我们识别出7232例腹腔镜骶骨阴道固定术、1560例腹腔镜直肠固定术以及123例同时进行腹腔镜骶骨阴道固定术和直肠固定术的病例。同时进行这两种手术的患者更常见为白人、非西班牙裔、非糖尿病患者且吸烟。同时进行这两种手术的患者手术时间最长，其次是骶骨阴道固定术和直肠固定术（p < 0.0001）。单独接受直肠固定术的患者更常见为美国麻醉医师协会分级≥3级（p < 0.0001）。骶骨阴道固定术、直肠固定术以及同时进行这两种手术的任何并发症发生率无差异（6.18%、7.63%、8.94%；p = 0.058）。骶骨阴道固定术、直肠固定术以及同时进行这两种手术的严重并发症发生率无差异（5.52%、6.35%、8.13%；p = 0.222）。单独比较直肠固定术与骶骨阴道固定术，发生任何并发症的几率更高（调整后的优势比 = 1.252，95%可信区间1.002 - 1.565）。比较所有组，直肠固定术的死亡率、再次手术率和输血率最高（均p < 0.05）。同时进行这两种手术的患者手术部位感染率和尿路感染率最高（均p < 0.05）。
这三种手术的并发症发生率均较低。对于精心挑选的患者，同时进行修复可能是合适的。
