title: Systematic assessment of surgical complications in 438 cases of vaginal native tissue repair for pelvic organ prolapse adopting Clavien-Dindo classification.
abstract: OBJECTIVE
  To systematically review surgical complications of vaginal native tissue prolapse repair using Clavien-Dindo classification and to show whether concomitant surgery leads to increased complication rates.
  
  
  METHODS
  Retrospective analysis of complications in 438 consecutive vaginal native tissue prolapse repairs and subgroup analysis was performed for concomitant hysterectomy or sacrospinous fixation for level I defects using Fisher's exact tests.
  
  
  RESULTS
  Anterior and posterior colporrhaphia was performed in all 438 patients and sacrospinous fixation (SSF) for level I defects in 269 patients. Prolapse repair was combined with hysterectomy in 255 cases. One intra-operative bladder lesion (0.23%) and one rectal lesion (0.23%) occurred. Postoperative urinary tract infection requiring antibiotics was noted in 34 cases (7.8%). Post-void residual volume was medically treated in 24 cases (5.5%). Four patients (0.9%) underwent postoperative suprapubic catheter insertion. Asymptomatic gluteal hematomas were noted in 11 cases (2.5%). Four patients (0.9%) underwent re-operations for postoperative hemorrhage. Mean hospital stay was 5.6 days. Minor complications were classified as CD grade I in 2.5%, as CD grade II in 13.2%, complications requiring surgical intervention as grade IIIa in 0.9% and as grade IIIb in 0.9% of patients. No CD grade IV or V complications occurred. Apart from gluteal hematomas classified as CD grade I occurring in the SSF group (p = 0.019), no other differences of complication rates were found in the hysterectomy subgroup or in the SSF subgroup.
  
  
  CONCLUSIONS
  Surgery was associated with low rate of CD grade III complications. Re-operation rate was 0.9%. The authors suggest introduction of CD classification for comparability of prolapse surgery.
authors.affiliation: Department of Gynecology and Obstetrics, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstreet 18, 07743, Jena, Germany.
authors.forename: Anke R
authors.initials: AR
authors.lastname: Mothes
authors.forename: Henning K
authors.initials: HK
authors.lastname: Mothes
authors.forename: Marc P
authors.initials: MP
authors.lastname: Radosa
authors.forename: Ingo B
authors.initials: IB
authors.lastname: Runnebaum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D007902:Length of Stay; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000145:classification / Q000601:surgery; D011183:Postoperative Complications / Q000145:classification*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011785:Quality Assurance, Health Care; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000209:etiology; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery