Perioperative adverse events associated with colpocleisis for uterovaginal and posthysterectomy vaginal vault prolapse

Audra Jolyn Hill, Mark D Walters, Cecile A Unger
American Journal of Obstetrics and Gynecology 2016, 214 (4): 501.e1-501.e6

BACKGROUND: Colpocleisis, a vaginal obliterative procedure, offers women with symptomatic pelvic organ prolapse an effective, durable anatomic repair and is associated with high patient satisfaction rates. Historically, colpocleisis was reserved for the medically frail or elderly with the goal of limiting anesthetic exposure, decreasing operative time, and minimizing adverse events. Several colpocleisis and colpectomy procedures exist and limited evaluation has been performed comparing these differences in regards to perioperative adverse events.

OBJECTIVE: The primary objective was to describe the overall rate of perioperative adverse events in patients undergoing colpocleisis. The secondary objective was to compare rates of adverse events between different colpocleisis procedures.

STUDY DESIGN: This is a retrospective chart review of patients who underwent colpocleisis at a tertiary care center from January 2003 through December 2013. Subjects were identified by their Current Procedural Terminology (CPT) codes and categorized into 3 groups: (1) partial or complete vaginectomy/colpectomy (CPT 57106, 57110); (2) vaginal hysterectomy with total or partial colpectomy (CPT 58275, 58280); and (3) Le Fort colpocleisis (CPT 57120). Baseline demographics, perioperative data, and postoperative data were collected. Analysis of variance was used to describe perioperative and postoperative adverse events in all subjects and to compare outcomes among the 3 groups.

RESULTS: In all, 245 subjects underwent colpocleisis during the study period. Mean age and body mass index were 78 (±7) years and 27.7 (±5.8) kg/m(2), respectively; 59.1% (140/245) of subjects had stage-4 prolapse. The most common adverse event was urinary tract infection occurring in 34.7% of subjects. Major adverse events were uncommon. There were no differences in event rates among the groups except for the following: patients undergoing concurrent vaginal hysterectomy had longer mean operative time (144 vs 108 vs 111 minutes, P = .0001), had higher estimated blood loss (253 vs 135 vs 146 mL, P = .0001), and were more likely to experience postoperative venous thromboembolism (4.6% vs 0% vs 0%, P = .01). After controlling for age, body mass index, medical comorbidities, estimated blood loss, and operative time, the risk of venous thromboembolism was no longer significant.

CONCLUSION: The overall rate of major perioperative and postoperative adverse events in women undergoing colpocleisis is low; however, concomitant hysterectomy is associated with longer operative times and higher blood loss.

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