Safety and medium-term outcome of redo laparoscopic sacrocolpopexy: a matched case-control study.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: In the case of recurrent apical prolapse following laparoscopic sacrocolpopexy (LSCP), one may consider a "redo" procedure. We hypothesized that redo LSCP may carry an increased complication risk and less favorable outcomes when compared with primary procedures. METHODS: This is a single-center, matched case-control (14) study, comparing all 39 women who had a redo LSCP and 156 women who had a primary LSCP for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. Matching was based on proximity to the operation date. The primary outcome was the occurrence of intraoperative and early postoperative complications within 3 months. Secondary outcomes included subjective (Patient Global Impression of Change [PGIC] ≥4) and objective (Pelvic Organ Prolapse Quantification [POP-Q] stage <2) success rates, surgical variables, graft-related complications and reinterventions. RESULTS: There was no difference in the rate of intraoperative and early postoperative complications (redo 21.1% vs control 29.8%, OR 0.63, 95% CI 0.27-1.48). The conversion rate was higher in redo patients (redo 10.3% vs control 0.6, OR 17.71, 95% CI 1.92-163.39). Early postoperative complications were comparable they were mainly infectious and managed by antibiotics. At a comparable follow-up (redo 81 months (IQR 54) vs control 71.5 months (IQR 42); p=0.37), there were no differences in graft-related complications (redo 17.9% vs control 9.6%, p=0.14) and reinterventions for complications (redo 12.8% vs control 5.1%, p=0.14) or prolapse (redo 15.4% vs control 8.3%, p=0.18). Subjective (redo 88.5% vs control 80.2%, p=0.41) and objective (redo 31.8% vs control 24.7%, p=0.50) success rates were also comparable. CONCLUSIONS: In our experience, redo LSCP is as safe and effective as a primary LSCP, but there is a higher risk of conversion.