Journal of Minimally Invasive Gynecology | 2019
Feasibility of Outpatient Combined Laparoscopic Apical and Vaginal Prolapse Repair.
Abstract
Study Objective To assess the feasibility of outpatient laparoscopic management of apical pelvic organ prolapse along with indicated vaginal repairs and anti-incontinence procedures. Design Retrospective cohort study. Setting Tertiary-care academic center, Boston, MA. Patients or Participants 112 patients seen in the Minimally Invasive Gynecologic Surgery (MIGS) and Urogynecology clinics with symptomatic pelvic organ prolapse. Interventions Laparoscopic hysterectomy, sacro (cervico- or colpo-) pexy along with vaginal prolapse and anti-incontinence procedures as indicated from 2013-2017 at Brigham & Women s Hospital and Brigham & Women s Faulkner Hospital performed by a MIGS and Urogynecology team. Measurements and Main Results Of the 112 patients, 52 were outpatient and 60 were admitted (median stay in admission group\u202f=\u202f1 day; range 1-3). Patient baseline characteristics, ASA class, and POP-Q stage were similar between the outpatient and admitted cohorts. Most patients underwent hysterectomy at the time of the sacropexy (65.4% outpatient vs 73.3% admitted, p= .08). Concomitant AP repair was more common in the outpatient group (98.1% vs 85%, p\u202f=\u202f.02). The proportion of outpatient procedures increased from 17% in 2013 to a peak of 70% in 2016. OR time was shorter for the outpatient cohort (103.9 mins vs 115.5 mins, p\u202f=\u202f.04), but other peri-operative outcomes were similar. There were no intra-operative complications. Post-operative complications, readmission and re-operations were low and similar between outpatient and admitted cohorts. No factor was predictive of admission on regression analysis. Conclusion Laparoscopic apical prolapse repair with concomitant vaginal repairs can be performed safely as an outpatient procedure. A unique team approach may foster a shorter, more efficient procedure without compromising short term outcomes.