Laparoscopic colposacropexy: a safe approach in elderly patients.

Lorca J1, López-Fando L1, Sánchez Guerrero C1, Santiago González M1, Ruiz Hernández M1, Sánchez Á1, Jiménez Cidre M1, Burgos Revilla F1

Research Type

Clinical

Abstract Category

Geriatrics / Gerontology

Abstract 407
E-Poster 2
Scientific Open Discussion ePoster Session 18
Thursday 5th September 2019
13:15 - 13:20 (ePoster Station 12)
Exhibition Hall
Pelvic Organ Prolapse Surgery Gerontology
1.Hospital Universitario Ramón y Cajal. Urology department. Instituto Ramón y Cajal de Investigación Sanitaria ( IRYCIS ).
Presenter
L

Luis Lopez-Fando Lavalle

Links

Poster

Abstract

Hypothesis / aims of study
The population aging means that the incidence of patients with prolapse has increased in recent years. Vaginal surgery has been traditionally favored in these patients due to a shorter surgical time, a shorter stay and less invasiveness. There is not enough literature of the results of the laparoscopic approach in these patients, having the perception of greater safety and tolerability for the vaginal approach. 
The aim of the study is to compare the demographic variables, surgical variables and the presence of surgical complications among the different age groups of patients who underwent laproscopic colposacropexy , in order to show if there are significant differences for patients> 75 years.
Study design, materials and methods
We selected patients from the prospective base of 217 laparoscopic Colposacropexy operated in the Urology Department of our center from May 2012 to May 2018. Patients were divided in three groups according to their age: < 75 , 75-80 , >80. 
Retrospective analysis of demographic (age ,  BMI , gestations , hypertension , diabetes, dyslipemia , cardiovasular disease, respiratory disease , prior surgery prolapse, anticoagulant treatment and antiaggregate treatment)  surgical variables ( time, hospitalization days and conversion to open surgery) surgical complications was performed. The Clavien Dindo (CD)  and ICS-IUGA classification was used for postoperative complications. Complications rates between >75 and <75 were analysed with Chi2 pearson test.
Results
* Surgical indication is similar according to age, we obtained  163 patients < 75 years ,  36 patients 75-80 years  and 15 >80 years.

 AGE	2012-2014	2014-2016	2016-2018	 Total. 
<75	         64(75,2%)	65(78,3%)	34(69,3%)	163
75-79	 17(20%)	12(14,4%)	10(20,4%)	  39
>80	          4(4,7%)    	  6(7,2%)	          5(10,2%)	  15
Total	85(100%)	83(100%)	49(100%)	217

No significant differences ( p<0.05)  were found in the demographic variables. BMI(median range): 25,6 (16.6-17.3) Gestations(median range): 3(0-8),  Hypertension: 53,9% (117/217),  Diabetes: 21,2% (23/217), Dyslipemia: 36,9% (80/217), Cardiovasular disease: 10,1% (22/217) , Respiratory disease: 10,6% (23/217),  Prior Surgery Prolapse: 18,4% (40/217), Anticoagulant: 4,6% (10/217) , Antiaggregate: 18% (39/217). Results are sumarized in table 1.

	                     TOTAL	         <75	       75-80	                >80
Time(min)	160(90-360)	 180( 90-360)   150(90-300)	120( 90-300)
Days Hospit	     3(2-13)	      3 ( 2-13)	        3(2-9)	            3( 2-4)
Conversion	     0%	 	 	
 
* No differences found ( p<0,05) between age groups. There was no conversion to open surgery .

*No significant differences ( p<0.05)  were found in  the complications between age groups. Intraoperative complications (1.8% (3/21)) were bladder perforation, vaginal perforation and bowel perforation. In Postoperative comlications we has : Clavien-Dindo I 2,3%(5/217): 2 vaginal bleeding and 3 constipation;   Clavien-Dindo II 9,2%(20/217): 12 urinary tract infections,  5 haematomas ; 2 wound Infection, 1 deep-vein thrombosis; Clavien-Dindo III 1,8%(4/217): 1 anaphylactic  shock, 1 ureteral fistula, 1 bowel obstruction , 1 eventration. There were no Clavien-Dindo IV-V. Results are sumarized in table 2.
Interpretation of results
Surgical indication among the age groups has remained stable over the years. Regarding the demographic variables, no significant differences were observed with respect to cardiovascular risk factors or previous prolapse surgery, a higher percentage of anticoagulant therapy was observed in patients> 80, however it did not result in greater surgical complications due to bleeding. 
We did not observe a longer surgical time or longer hospital stay in patients older than 75 years.In addition, there was a higher percentage of cardiovascular and respiratory disease in patients> 75 years without a greater number of complications in this group.
We did not observe differences in post-surgical complications, being the most frequent urinary tract infections (UTI).
Concluding message
Our data show that laparoscopic colposacropexy in patients >75 years has an acceptable safety profile with a short hospital stay and an acceptable surgical time. These laparscopic approach in these patients provide the benefits of abdominal mesh placement in terms of recurrence compared to surgery without mesh and of extrusion compared to vaginal mesh surgery.
Figure 1 Table 1. Dempgraphic variables between age group
Figure 2 Table 2. Complications between age groups
Disclosures
Funding We do not have conflict of interest Clinical Trial No Subjects Human Ethics not Req'd It is a Retrospective analysis Helsinki Yes Informed Consent Yes