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Factors associated with failure of site specific repair for prolapse in a regional Australian centre
IUGA Academy. Harrington P. Jun 30, 2018; 213061; 302 Topic: Pelvic Organ Prolapse
Dr. Patrick Harrington
Dr. Patrick Harrington

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302

Factors associated with failure of site specific repair for prolapse in a regional Australian centre

Koroznikova, N1;Harrington, P1; Lambert, N1; Bardsley, M2

1: Ballarat Health Services; 2: OGB, Ballarat

Introduction: Site-specific vaginal repairs aim to re-attach the fascial supports and repair the breaks in the fascia in order to correct prolapse 1-3 . It is a commonly performed surgical procedure for treatment of pelvic organ prolapse. While it is considered a viable alternative to the traditional colporrhaphy procedure there does not exist a triaging tool to determine which clients are at higher risk for failure of this technique.

Objective: This study was to determine if there were common patient factors associated with failure of site specific repair for pelvic organ prolapse and whether it would be possible to generate a predictive algorithm for those at risk of surgical management failure.

Methods: A retrospective study was undertaken examining all patients from a private practice in a regional setting who have had site specific vaginal repair performed over a 10 year period (2007 - 2016). These procedures were carried out by one gynaecologist with a special interest in pelvic organ repair. The type of repair was decided by the specialist and was dictated by presenting symptoms and examination findings. Patient files and operation notes were examined with demographics, BW scale, pre-operative symptoms and type of procedure performed recorded. The failure rate was determined and studied in comparison to client demographics. Failure was defined as incomplete resolution of symptoms, vaginal examination findings and patient satisfaction (interpreted from the notes) at the 12 month mark. 511 patients were identified to have had a site specific vaginal repair performed in the specified time frame with 29 of those having failed treatment. Statistical analysis was performed to determine what factors were associated with failed treatment.

Results: 29 patients had no benefit form initial surgery and thus been classified as had failed surgical management provided. 3.7% of the 294 patients that had posterior site-specific procedure had a posterior compartment failure. 11.7% of the 60 patients that had anterior site-specific procedure had a return of same symptoms and same exam findings < 1 yr. 14.3% of the 7 patients that had both anterior site specific and posterior site specific failed. The mean age of those clients who failed was 62.58 (46 – 82)and parity was 2.9 (2 – 5). Other associations between client demographics were also identified when statistical analysis was performed.

Conclusions: Site specific repair technique is a valuable and highly successful method of prolapse repair, however there is a significant failure rate. In this study failure rate was 5.6% which is lower than that quoted from IUGA resources. We were able to determine a trend in patient demographics which were associated with a higher failure rate. While long term follow up of this cohort is not reported it gives both promising support to this style of repair and also the potential to develop a predictive algorithm for those at risk of failure of surgical management.

References:

  1. Kovac SR, Zimmerman CW. Advances in Reconstructive Vaginal Surgery. 1st ed. Lippincott Williams and Wilkins; 2006.
  2. Chaliha C, Khullar V. Surgical repair of vaginal prolapse: A gynaecological hernia. International Journal of Surgery. 2006; 4: 242 – 250. DOI: 10.1016/j.ijsu.2005.10.015
  3. Kudish BI, Iglesia CB. Posterior Wall Prolapse and Repair. Clinical Obstetrics and Gynaecology. 2010; 53 (1): 59-71.

Disclosure:

Work supported by industry: no.

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