Obstet Gynecol Sci.  2014 Jul;57(4):304-309. 10.5468/ogs.2014.57.4.304.

Significant gastrointestinal morbidity after sacrocolpopexy: The incidence and risk factors

• Jo YR
• Kim JY
• Jeon MJ

• KMID: 1841542
• DOI: http://doi.org/10.5468/ogs.2014.57.4.304

Abstract

OBJECTIVE
This study aimed to quantify the risk of significant gastrointestinal (GI) morbidity after sacrocolpopexy (SCP), and to identify related risk factors.
METHODS
A retrospective study was performed of 258 patients who underwent laparotomic SCP for symptomatic pelvic organ prolapse (POP) from November 2008 to August 2013. By the review of medical records, the frequency of significant GI morbidity that resulted in a prolonged initial hospitalization, readmission, or reoperation was assessed. Thereafter, risk factors for significant GI morbidity were assessed using univariate and multivariate analyses.
RESULTS
Ten patients (3.9%) were identified as having significant GI morbidity; nine (3.5%) had a prolonged initial hospital stay or were readmitted for the medical treatment of postoperative ileus and 1 (0.4%) underwent reoperation for small bowel obstruction. The occurrence of significant GI morbidity was significantly associated with patient's age and prior laparotomy. By multivariable logistic regression analysis, age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.01-1.27; P=0.03) and prior laparotomy (OR, 6.82; 95% CI, 1.37-34.07; P=0.02) were found as independent risk factors for significant GI morbidity.
CONCLUSION
One in 25 (3.9%) women after SCP experiences significant GI morbidity. Particularly, women with older age and prior laparotomy have a higher risk for significant GI morbidity. This data will aid preoperative counseling for Korean POP patients undergoing SCP.

Keyword

Gastrointestinal morbidity; Pelvic organ prolapse; Prior laparotomy; Risk factors; Sacrocolpopexy

MeSH Terms

Counseling
Female
Hospitalization
Humans
Ileus
Incidence*
Laparotomy
Length of Stay
Logistic Models
Medical Records
Multivariate Analysis
Pelvic Organ Prolapse
Reoperation
Retrospective Studies
Risk Factors*

Reference

1. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001; 98:646–651.

2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89:501–506.

3. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009; 114:1278–1283.

4. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013; 4:CD004014.

5. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004; 104:805–823.

6. Whitehead WE, Bradley CS, Brown MB, Brubaker L, Gutman RE, Varner RE, et al. Gastrointestinal complications following abdominal sacrocolpopexy for advanced pelvic organ prolapse. Am J Obstet Gynecol. 2007; 197:78.e1–78.e7.

7. Warner WB, Vora S, Alonge A, Welgoss JA, Hurtado EA, von Pechmann WS. Intraoperative and postoperative gastrointestinal complications associated with laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2012; 18:321–324.

8. Curry WT Jr, Carter BS, Barker FG 2nd. Racial, ethnic, and socioeconomic disparities in patient outcomes after craniotomy for tumor in adult patients in the United States, 1988-2004. Neurosurgery. 2010; 66:427–437.

9. Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000; 57:Suppl 1. 108–145.

10. Oh-Park M, McGinn A, Lipsitz E, Thomas M, Zonszein J. Racial disparity in amputation-free survival after infrainguinal bypass procedure: contribution of socioeconomic status. Am J Phys Med Rehabil. 2009; 88:986–994.

11. Kirby JB, Taliaferro G, Zuvekas SH. Explaining racial and ethnic disparities in health care. Med Care. 2006; 44(5):Suppl. I64–I72.

12. Jeon MJ, Moon YJ, Jung HJ, Lim KJ, Yang HI, Kim SK, et al. A long-term treatment outcome of abdominal sacrocolpopexy. Yonsei Med J. 2009; 50:807–813.

13. Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg. 2000; 87:1480–1493.

14. Ferraz AA, Cowles VE, Condon RE, Carilli S, Ezberci F, Frantzides CT, et al. Nonopioid analgesics shorten the duration of postoperative ileus. Am Surg. 1995; 61:1079–1083.

15. Ogilvy AJ, Smith G. The gastrointestinal tract after anaesthesia. Eur J Anaesthesiol Suppl. 1995; 10:35–42.

16. Svatek RS, Fisher MB, Williams MB, Matin SF, Kamat AM, Grossman HB, et al. Age and body mass index are independent risk factors for the development of postoperative paralytic ileus after radical cystectomy. Urology. 2010; 76:1419–1424.

17. Grosso G, Biondi A, Marventano S, Mistretta A, Calabrese G, Basile F. Major postoperative complications and survival for colon cancer elderly patients. BMC Surg. 2012; 12:Suppl 1. S20.

18. Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, et al. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005; 7:551–558.

19. Dite P, Lata J, Novotny I. Intestinal obstruction and perforation: the role of the gastroenterologist. Dig Dis. 2003; 21:63–67.

20. Schwenk W, Bohm B, Haase O, Junghans T, Muller JM. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg. 1998; 383:49–55.

21. Barmparas G, Branco BC, Schnuriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg. 2010; 14:1619–1628.

22. Leung KL, Lai PB, Ho RL, Meng WC, Yiu RY, Lee JF, et al. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma: a prospective randomized trial. Ann Surg. 2000; 231:506–511.

23. Al-Took S, Platt R, Tulandi T. Adhesion-related small-bowel obstruction after gynecologic operations. Am J Obstet Gynecol. 1999; 180(2 Pt 1):313–315.