Ann-Sophie Page

Chapter 4.2.2 90 As shown in Figure 1, there was a non-significant difference in the rate of reinterventions for late complications (redo 12.8% [5/39] vs control: 5.1% [8/156], HR: 1.73, 95% CI: 0.45-6.60). All reinterventions in the redo group (5/5) were performed for symptomatic GRC, while 2/8 patients in the control group had a reintervention for non-GRC. Both involved suprapubic incisional hernias following subtotal hysterectomy with removal of the uterine specimen through this trocar site. Along the same lines, there was a trend for more GRC (redo: 17.9% [7/39] vs control: 9.6% [15/156], HR: 1.38, 95% CI: 0.50-3.83) and reinterventions for GRC (redo: 12.8% [5/39] vs control: 3.8% [6/156], HR: 2.40, 95% CI: 0.56-10.26) in the redo group (A1). GRC were symptomatic in all but one patient in the redo group (85.7%, 6/7), whereas in the control group only 9/15 patients (60%) with GRC had symptoms (p=0.35). One redo patient required a cystectomy with ileal urinary diversion (Bricker) for a persistent vesicovaginal fistula. She underwent multiple vaginal procedures following redo surgery, including an unsuccessful attempt to implant an artificial urinary sphincter which was complicated by a bladder lesion. Figure 1. Time course of reinterventions for complications beyond three months after surgery in both groups Outcome Of the 195 operated patients, 153 (78.5%) agreed to participate in the audit, hence self-reported outcomes. Reasons for non-participation are displayed in Figure 2. Participation rates did not differ between groups (redo: 76.9% [30/39] vs control: 78.8% [123/156], p=0.79). Participants who had a reintervention for POP recurrence (redo: 13.3% [4/30] vs control: 9.8% [12/123]) were excluded from this analysis, as most of them (75%, 12/16) were reoperated before audit. Patient satisfaction was comparable (Figure 3). At a median follow-up of 71.5 months (IQR: 43.5), 23/26 participants (88.5%) in the redo group reported subjective improvement. In the control group, 89/111 participants (80.2%) reported subjective improvement at a median follow-up of 65 months (IQR: 33) (OR: 1.90, 0.52-6.89). Graphical display of the time course of the rate of reinterventions for late complications in the two study groups (HR: 1.73, 95% CI: 0.45-6.60). Confidence intervals are indicated by dotted lines. Statistical comparison between groups was performed by log-rank (Mantel- Haenszel) testing.

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