To rest or not to rest after sacral colpopexy? Dispelling an old custom in the ERAS time

Despite the advent of the ERAS Program, recovery after urogynecological surgery is still a highly debated topic in clinical practice. The majority of gynecologic surgeons, in fact, continue to advise patients to home rest and to avoid lifting heavy objects after surgery. The aim of the present study was to verify the impact of a moderate-high physical activity and recovery after surgery on anatomical results after LSC, with a 2-year follow-up (FU).

Two hundred and one consecutive patients with pelvic prolapse were retrospectively selected from our database among women who underwent, from October 2019 to February 2022, a laparoscopic sacral colpopexy. Three-six and 24 months follow-up were studied. At 3 months, patients completed the IPAQ-SF Questionnaire to assess physical activity. According to IPAQ-SF, patients were divided in two arms: Low and Moderate-High activity level.

At 3 months follow-up, we obtained a high anatomic success rate in absences of statistical differences between populations, with a significative persistence of these results even at 6 and 24 months. No differences were found in terms of subjective success and vaginal mesh erosions at 3-6 months and 2-years follow-ups between patients despite differences in IPAQ-SF activity levels.

Our data highlight the need for urogynecologists, especially after LSC, to invest heavily in patient education and to shift away from the outdated concept of home rest after surgery.