Abstract
Introduction and hypothesis
We sought to assess the incidence, symptoms, and risk factors of perioperative hemorrhagic complications in patients undergoing pelvic floor reconstructive surgery.
Methods
This is a retrospective study on 694 consecutive patients who underwent pelvic floor reconstructive surgery with or without using mesh in our hospital over a 3-year period.
Results
We identified 694 pelvic floor reconstructive procedures from 2014 to 2016, including complete/incomplete colpocleisis (176, 25.4%), sacral colpopexy/hysteropexy with mesh (140, 20.1%), colporrhaphy (77, 11.1%) or vaginal mesh repair (99, 43.1%). Two patients who received only sacrospinous ligament suspension were excluded. There were 68 (9.8%) and 3 (0.1%) patients whose blood loss reached 200 and 500 ml respectively. Procedures involving mesh and vaginal hysterectomy (VH) caused more intraoperative blood loss. Postoperative hemoglobin drop was least in colpocleisis (p < 0.05). All 6 of the patients (0.9%) who developed postoperative pelvic hematoma underwent concomitant VH, and 5 of them received mesh.
Conclusions
Hemorrhagic complications during or after pelvic floor reconstructive surgery are rare. Mesh use and concomitant VH are two major surgical risk factors for hemorrhagic complications in pelvic floor reconstructive surgery.
Similar content being viewed by others
References
Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501.
Bako A, Dhar R. Review of synthetic mesh-related complications in pelvic floor reconstructive surgery. Int Urogynecol J. 2009;20(1):103.
Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic surgery transfusion hemoglobin European overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43(4):459.
Park JH, Rasouli MR, Mortazavi SM, Tokarski AT, Maltenfort MG, Parvizi J. Predictors of perioperative blood loss in total joint arthroplasty. J Bone Joint Surg Am. 2013;95(19):1777–83.
Fitzgerald MP, Richter HE, Siddique S, et al. Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):261–71.
Sung VW, Weitzen S, Sokol ER, et al. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006;194(5):1411–7.
Von Pechmann WS, Mutone M, Fyffe J, et al. Total colpocleisis with high levator plication for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol. 2003;189(1):121–6.
Hill AJ, Walters MD, Unger CA. Perioperative adverse events associated with colpocleisis for uterovaginal and post-hysterectomy vaginal vault prolapse. Am J Obstet Gynecol. 2016;214(4):501.e1.
Jones KA, Zhuo Y, Solak S, et al. Hysterectomy at the time of colpocleisis: a decision analysis. Int Urogynecol J. 2016;27(5):805–10.
Hoffman MS, Cardosi RJ, Lockhart J, et al. Vaginectomy with pelvic herniorrhaphy for prolapse. Am J Obstet Gynecol. 2003;189(2):370–1.
Segev Y, Auslender R, Lissak A, et al. Symptomatic pelvic hematoma following transvaginal reconstructive pelvic surgery: incidence, clinical presentation, risk factors, and outcome. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):211–4.
Thomson AJ, Sproston AR, Farquharson RG. Ultrasound detection of vault haematoma following vaginal hysterectomy. Br J Obstet Gynaecol. 1998;105(2):211.
Wood C, Maher P, Hill D. Bleeding associated with vaginal hysterectomy. Aust NZ J Obstet Gynaecol. 1997;37(4):457.
Slavotinek J, Berman L, Burch D, et al. The incidence and significance of acute post-hysterectomy pelvic collections. Clin Radiol. 1995;50(5):322–6.
Dane C, Dane B, Cetin A, et al. Sonographically diagnosed vault hematomas following vaginal hysterectomy and its correlation with postoperative morbidity. Infect Dis Obstet Gynecol. 2009;2009:91708.
Morris EP, Eltoukhy T, Toozshobson P, et al. Refining surgical technique to prevent occurrence of vault haematoma after vaginal hysterectomy. J Obstet Gynaecol. 2001;21(4):379–82.
Malinowski A, Mołas J, Maciołekblewniewska G, et al. The modification in surgical technique of incision and closure vault of the vagina during vaginal hysterectomy on the incidence of vault haematoma. Ginekol Pol. 2006;77(2):117–25.
Caveney M, Haddad D, Matthews C, et al. Short-term complications associated with the use of transvaginal mesh in pelvic floor reconstructive surgery: results from a multi-institutional prospectively maintained dataset. Neurourol Urodyn. 2017;36(8):2044–8.
Kasyan G, Abramyan K, Popov AA, et al. Mesh–related and intraoperative complications of pelvic organ prolapse repair. Cent European J Urol. . 2014;67(3):296.
Ganj FA, Ibeanu OA, Bedestani A, et al. Complications of transvaginal monofilament polypropylene mesh in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(8):919–25.
Demirci F, Birgul K, Demirci O, et al. Perioperative complications in vaginal mesh procedures using trocar in pelvic organ prolapse repair. J Obstet Gynaecol India. 2013;63(5):328–31.
Balchandra P, Marsh F, Landon C. Perioperative outcomes and prospective patient reported outcome measures for transvaginal mesh surgery. Arch Gynecol Obstet. 2015;292(4):875–82.
Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079.
Biomet 2011. Available from: http://www.biomet.com/biologics/timesh.cfm.
Lasala CA, Schimpf MO. Occurrence of postoperative hematomas after prolapse repair using a mesh augmentation system. Obstet Gynecol. 2007;109(2):569–72.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Rights and permissions
About this article
Cite this article
Cheng, W., Bu, C., Hong, F. et al. Perioperative hemorrhagic complications in pelvic floor reconstructive surgery. Int Urogynecol J 30, 1141–1146 (2019). https://doi.org/10.1007/s00192-018-3667-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-018-3667-6