title: Surgical outcomes of abdominal versus laparoscopic sacral colpopexy related to body mass index.
abstract: OBJECTIVE
  Obesity can predispose women to pelvic organ prolapse and can also affect the success of prolapse surgery. Sacral colpopexy is a common surgical approach used to treat significant prolapse, and may be performed by laparotomy or laparoscopy. The objective of this study was to determine whether surgical outcomes following abdominal sacral colpopexy (ASC) and laparoscopic sacral colpopexy (LSC) varied according to BMI.
  
  
  METHODS
  We conducted a retrospective cohort study of women who had undergone ASC (n = 90) and LSC (n = 150). Preoperative, perioperative, and postoperative information was collected from patient charts and entered into a database according to BMI category (normal weight 18.5 to 24.9 kg/m², overweight = 25 to 29.9 kg/m², obese ≥ 30 kg/m²). Within each BMI group, outcomes were compared between ASC and LSC patients using Student t, Mann-Whitney U, and Fisher exact tests, and analyses of covariance.
  
  
  RESULTS
  In normal weight patients, postoperative apical measurements were worse in ASC patients (P = 0.01). In overweight patients, the ASC group had worse posterior measurements (P = 0.05) and fewer mesh/suture erosions (P = 0.03) but more recurrent prolapse symptoms (P = 0.007). In obese patients, the ASC group had better anterior measurements (P = 0.008). There were no differences in any BMI category for prolapse stage, surgical satisfaction, or classification of surgical success or failure (P > 0.05).
  
  
  CONCLUSIONS
  Differences between ASC and LSC were identified when patients were categorized according to BMI. These findings may be useful in counselling patients and planning the appropriate surgical approach for sacral colpopexy based on BMI.
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto,Toronto ON.
authors.forename: Colleen D
authors.initials: CD
authors.lastname: McDermott
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Methodist Hospital, Indiana University Health,Indianapolis IN.
authors.forename: Jean
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Biostatistics, Methodist Hospital/Indiana University Health, Indianapolis IN.
authors.forename: Colin L
authors.initials: CL
authors.lastname: Terry
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Methodist Hospital, Indiana University Health,Indianapolis IN.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Woodman
authors.affiliation: Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Methodist Hospital, Indiana University Health,Indianapolis IN.
authors.forename: Douglass S
authors.initials: DS
authors.lastname: Hale
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery