Bradley MS, et al. - Researchers aimed at comparing anatomic failure after robotic-assisted sacrocolpopexy among three groups of patients categorized by their pre- and post-operative genital hiatus size. After robotic sacrocolpopexy, surgical reduction of an enlarged pre-operative genital hiatus decreased early composite anatomic failure, this was specifically related to the posterior compartment.

Methods

• From 1/2013 to 9/2016, a retrospective cohort study was performed of women who underwent robotic-assisted sacrocolpopexy.
• A wide GH was defined as ≥4cm and a normal GH as <4cm.
• Three groups were compared:
• 1) Wide Pre- and Post-operative GH (Persistently Wide);
• 2) Wide Pre- and Normal Post-op GH (Improved); and
• 3) Normal Pre- and Post-operative GH (Stably Normal).
• Researchers primarily assessed composite anatomic failure; this was defined as either recurrent prolapse in any compartment past the hymen or retreatment for prolapse with either surgery or pessary.
• One-way ANOVA and chi-square test were used to analyze the data.
• Independent risk factors for anatomic failure between the three groups were evaluated using logistic regression analysis.
• For this study, P < 0.05 was considered significant.

Results

• Study population was comprised of 452 women; mean age was 59.3±10.0 years; mean body mass index was 27.8±5.3 kg/m².
• Four hundred and forty seven women reported race; 394/447 (88.1%) were white.
• Distribution of the genital hiatus groups was as follows: 57 (12.6%) were Persistently Wide, 296 (65.5%) were Improved and 99 (21.9%) were Stably Normal.
• Less advanced preoperative prolapse (≥Stage 3) was reported by the Stably Normal group compared to the other groups (p < 0.01).
• Among groups, a similar percentage of patients had a concomitant posterior repair/perineoplasty (p=0.09); a total of 84 (18.6%) women underwent this procedure.
• In terms of overall composite anatomic failure, statistically significant difference was noted among the groups (p=0.03).
• The Persistently Wide group showed an increase in failure (14.0%) compared to the Improved Group (5.7%, p=0.04) and compared to the Stably Normal Group (4.0%, p=0.03).
• In a logistic regression model, the Persistently Wide group showed a 5.3-fold increased odds of composite anatomic failure (adjusted OR 5.3, 95% CI 1.4, 19.1; p=0.01) compared to the Stably Normal group controlling for number of vaginal deliveries and posterior repair/perineoplasty.
• In a sub-analysis of failure by compartment, the Persistently Wide Group showed an increase in failure of the posterior compartment compared to the Improved group (8.8% v. 2.0%, p<0.01), but not the Stably Normal group (3.0%, p=0.12).
• The groups showed no statistically significant difference in failure of the combined apical and anterior compartments (p=0.29).