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Female Sexual Function After Pure Transvaginal Appendectomy: A Cohort Study

  • 2011 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The impact of transvaginal natural orifice transluminal endoscopic surgery (NOTES) on female sexual function is unknown. We therefore performed a prospective cohort study of women undergoing pure transvaginal appendectomies (TVA) versus traditional laparoscopic appendectomies (LA). Using a validated, 19-point, female sexual function index questionnaire (FSFI) assessing six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain with intercourse), pre- and postoperative sexual function was compared.

Methods

Between August 2008 and August 2010, 42 patients with acute appendicitis were offered a pure TVA. Patients who did not wish to undergo a TVA underwent an LA and served as controls. Both groups were provided with an FSFI before surgery and at regular intervals for up to 1 year. Pre- and postoperative FSFI results were compared between cohorts using unpaired t tests, and between individuals within each cohort pre- and postoperatively using paired t tests.

Results

Twenty-two underwent LA, 18 patients underwent a pure TVA, and 2 refused participation in this study. Preoperative and >60 days postoperative FSFI data were available for 21 patients (10 LA and 11 TVA). Baseline FSFI scores were not significantly different between groups (LA, 19.3 ± 0.9; TVA, 19.3 ± 0.8, p = 0.99). FSFI scores at greater than 60 days postoperatively did not differ significantly from FSFI scores preoperatively in either group (LA, 19.3 ± 0.9 to 19.7 ± 0.7; p = 0.87; TVA, 19.3 ± 0.8 to 19.4 ± 0.9; p = 0.97). No FSFI domain in either cohort was significantly changed postoperatively.

Conclusions

Neither LA nor TVA affected female sexual function scores. This suggests that TVA does not have negative effects on female sexual function. The results of this study may prove beneficial in consultations with patients concerning the sexual sequelae of transvaginal surgery.

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References

  1. Rao GV, Reddy DN, Banerjee R: NOTES: human experience. Gastrointest Endosc Clin N Am. 2008:18:361–370; x.

    Article  PubMed  CAS  Google Scholar 

  2. Polychronidis A, Laftsidis P, Bounovas A, et al.: Twenty years of laparoscopic cholecystectomy: Philippe Mouret–March 17, 1987. JSLS. 2008:12:109–111.

    PubMed  Google Scholar 

  3. Bueno B: Primer Caso de Apendicectomia Por Via Vaginal. Tokoginecol Pract. 1949:8:152–158.

    PubMed  CAS  Google Scholar 

  4. Bernhardt J, Gerber B, Schober HC, et al.: NOTES–case report of a unidirectional flexible appendectomy. Int J Colorectal Dis. 2008:23:547–550.

    Article  PubMed  Google Scholar 

  5. Peterson CY, Ramamoorthy S, Andrews B, et al.: Women’s positive perception of transvaginal NOTES surgery. Surg Endosc. 2009:23:1770–1774.

    Article  PubMed  Google Scholar 

  6. Rosen R, Brown C, Heiman J, et al.: The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000:26:191–208.

    Article  PubMed  CAS  Google Scholar 

  7. Wiegel M, Meston C, Rosen R: The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005:31:1–20.

    Article  PubMed  Google Scholar 

  8. Di Tonno F, Mazzariol C, Optale G, et al. Evaluation of the female sexual function after vaginal surgery using the FSFI (Female Sexual Function Index). Urologia. Italy; 2007, p. 242–246.

  9. Standring S, Gray H. Gray’s anatomy the anatomical basis of clinical practice. Edinburgh: Churchill Livingstone/Elsevier; 2008.

    Google Scholar 

  10. Tunuguntla HS, Gousse AE: Female sexual dysfunction following vaginal surgery: myth or reality? Curr Urol Rep. 2004:5:403–411.

    Article  PubMed  Google Scholar 

  11. El-Toukhy TA, Hefni M, Davies A, et al. The effect of different types of hysterectomy on urinary and sexual functions: a prospective study. J Obstet Gynaecol. England; 2004, p. 420–425.

  12. Roussis NP, Waltrous L, Kerr A, et al. Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure. Am J Obstet Gynecol. United States; 2004, p. 1427–1428.

  13. Rhodes JC, Kjerulff KH, Langenberg PW, et al.: Hysterectomy and sexual functioning. JAMA. 1999:282:1934–1941.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Section of Gastrointestinal Surgery, Yale University School of Medicine, 40 Temple Street, Suite 7B, New Haven, CT, 06510, USA

    Daniel Solomon MD, Rachel Lentz MD, Andrew J. Duffy MD, Robert L. Bell MD, MA & Kurt E. Roberts MD

Authors
  1. Daniel Solomon MD
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  2. Rachel Lentz MD
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  3. Andrew J. Duffy MD
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  4. Robert L. Bell MD, MA
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  5. Kurt E. Roberts MD
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Corresponding author

Correspondence to Daniel Solomon MD.

Additional information

Discussant

Dr. Nathaniel J. Soper (Chicago, IL):

1. Logistics: Were the operations performed during regular hours or also at night? Was coordination with the gynecologist difficult? Do you still need a gynecologist to create and close the culdotomy?

2. Methods: What was the specific follow-up protocol re: interval of visits? Is consent an issue in patients requiring an emergency operation? Was a power analysis done to determine how many patients needed to be treated to assess differences in the primary outcome variable?

3. Results: Among only 21 patients with complete data—“average follow-up of 115 days”—was the questionnaire administered remotely or in person? Could the change in the “desire” domain be a result of a concern for injury during the vaginal closure?

4. Given the large body of work regarding sexual function after gynecologic procedures, the results of this study are not surprising. In the big picture, are the results of the NOTES appendectomies convincing enough for the authors to perform this operation routinely, or recommend it to a family member?

Closing Discussant

Dr. Daniel Solomon: The authors want to thank the SSAT for the privilege of presenting our work and Dr. Soper for his excellent questions.

1. We had the collaboration with two excellent gynecological surgeons who made themselves available 24 h a day to assist in the creation and closure of the culdotomy. Moreover, since the completion of this study, the operating surgeon has become credentialed at our institution to perform the culdotomy without gynecologic assistance.

2. Regarding follow-up, patients were seen once in the office per our routine at approximately 2 weeks postoperatively. Regarding consent, to facilitate truly informed consent, the operating surgeon was the only care provider authorized to obtain consent, and non-English speakers were excluded from this study. Though a power analysis was performed on the primary outcomes of our research protocol after a small proof of concept study, the sexual function outcomes we have presented were a secondary outcome and did not undergo a power analysis.

3. Preoperative questionnaires were provided in person, follow-up questionnaires were performed remotely by our research nurse. Given that there was no change in the desire domain and statistically insignificant improvements in the orgasm and pain domains postoperatively, it is unlikely that possible complications related to the culdotomy closure only affected the desire domain. That is why we hypothesize that the differences observed are more likely a statistical anomaly.

4. In soon to be published results of the primary outcomes of this study, we demonstrate significantly less postoperative pain and a significantly more rapid return to activity and work in women undergoing transvaginal appendectomy. Because these findings combined with non-inferiority with regards to postoperative sexual function, a similarly small complication rate, and the complete absence of scars, the authors are truly advocates this new surgical paradigm.

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Solomon, D., Lentz, R., Duffy, A.J. et al. Female Sexual Function After Pure Transvaginal Appendectomy: A Cohort Study. J Gastrointest Surg 16, 183–187 (2012). https://doi.org/10.1007/s11605-011-1706-4

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  • DOI: https://doi.org/10.1007/s11605-011-1706-4

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