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Obliterative Versus Reconstructive Prolapse Repair for Women Older than 70: Is There an Optimal Approach?
Sybil G Dessie1, Alex Shapiro, Miriam J Haviland
1From the *Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge; †Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center; and ‡Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
Objectives:
This study aimed to evaluate outcomes among women 70 years and older who underwent obliterative compared with reconstructive procedures for pelvic organ prolapse.
Methods:
This was a retrospective cohort study of patients 70 years and older who underwent surgical prolapse repair at our institution from January 2004 through June 2010. Only patients with at least 4 weeks of follow-up were included. Patient characteristics and relevant pre, intra, and postoperative information were abstracted from medical records. Severity of postoperative complications was classified using the Dindo surgical classification system.
Results:
We analyzed 143 (97.3%) patients. Fifty-four (37.8%) women underwent an obliterative procedure, whereas 89 (62.2%) underwent a reconstructive procedure. Twenty-eight (31.5%) women who had a reconstructive surgery met our criteria for recurrent prolapse compared with only 5 (9.3%) women in the obliterative group (P = 0.002).The incidence of intraoperative complication was 4.9%, and the incidence of any postoperative complication was 62.9%. Similar proportions of women who underwent each type of procedure experienced a postoperative complication. However, the severity of the complications differed between the groups (P = 0.02). In particular, 16.9% of women who had a reconstructive procedure experienced a grade III complication according to the Dindo scale compared with 13.0% of women who had an obliterative procedure.
Conclusions:
The majority of women 70 years and older do not have high-grade complications after pelvic organ prolapse repair, but women who undergo reconstructive procedures are more likely to experience high-grade complications and recurrent prolapse compared with women who undergo obliterative procedures.
