Perioperative hemorrhagic complications in pelvic floor reconstructive surgery

• Published in: International Urogynecology Journal Vol. 30; no. 7; pp. 1141 - 1146
• Main Authors: Cheng, Wenjin, Bu, Chunyan, Hong, Fanling, Zhong, Xiaozhu, Jin, Chengyue, Yang, Xin, Sun, Xiuli, Wang, Jianliu
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-07-2019; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Anemia; Blood Loss, Surgical; Blood tests; Blood transfusions; Female; Gynecology; Hematoma - etiology; Hemoglobin; Humans; Hysterectomy; Hysterectomy, Vaginal - adverse effects; Intraoperative Complications - etiology; Ligaments; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patients; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Plastic surgery; Reconstructive Surgical Procedures - adverse effects; Retrospective Studies; Risk Factors; Surgical Mesh - adverse effects; Surgical outcomes; Surgical techniques; Ultrasonic imaging; Urology; Vital signs; Vaginal hysterectomy; Mesh; Pelvic floor reconstruction; Complications; Hematoma; Blood loss
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-018-3667-6

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.