Redo SCP 89 Operation time, conversions and early complications We obtained complete data on both the intraoperative and early postoperative complications from the records of 189 of the 195 included patients (96.9%). Perioperative complication rates were comparable (Table 2). Details on the nature of these complications are provided in Table 3. A higher rate of conversions was observed in the redo group (redo: 10.3% [4/39] vs control: 0.6% [1/156], OR: 17.71, 95% CI 1.92-163.39). Three out of the four conversions were reactive. Two of these were for adhesions: the first was successfully completed as an open SCP, the second patient had a vaginal suspension instead. In the third patient, a vaginal repair was performed because the promontory could not be dissected due to adhesions and adiposity. One additional redo patient had a strategic conversion to an open SCP for anesthesiologic reasons (insufficient ventilatory parameters in steep Trendelenburg). In the control group, there was one reactive conversion following an accidental laceration of the iliac vein, which reportedly had an aberrant course at the level of the promontory. Bleeding was controlled by laparotomy and an uneventful further open SCP was performed. There was no difference in terms of median operation time (redo: 210 minutes (IQR 75) vs control: 190 minutes (IQR 90), p=0.69), median duration of adhesiolysis (redo: 5 minutes (IQR: 14) vs control: 4 minutes (IQR 17), p=0.94) and median estimated blood loss (redo: 100 cc (IQR: 150) vs control: 100 cc (IQR 150), p=0.89). Four redo patients (10.8%, [4/37]) had an operation time beyond 240 minutes (75th percentile in controls). Among these, one was the reactive conversion to an open SCP described above; the others were completed laparoscopically. The time-limiting step of two of the three laparoscopic procedures was the dissection of the vault. In the third it was the fixation of the new implant. In none of these patients, the initial mesh was removed. In both groups, most complications were infectious in nature and treated by a single course of antibiotics (redo: 12.8% [5/39] vs control: 17.9% [28/156], OR: 0.67, 95% CI 0.24-1.87), hence classified as Grade II. No grade III or higher complications occurred in the redo group. One patient in the control group had a grade IIIb complication, i.e., a sacrodiscitis nine weeks postoperatively, which coincided with a vaginal mesh exposure (ICS/IUGA 6CeT3S4). After two weeks of intravenous antibiotics, vaginal excision of the exposed mesh was performed under general anesthesia, following which the patient recovered completely. Late complications Median time from surgery until audit was 81 months (IQR: 54) in the redo group and 71.5 months (IQR: 42) in the control group (p=0.37). Data on the occurrence of GRC and reinterventions later than 3 months after surgery in non-participants, were obtained through the national electronic health record (n=67) or general practitioner (n=22), hence are provided for all 195 operated patients.
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