title: Complications and reoperations after laparoscopic sacrocolpopexy with a mean follow-up of 4 years.
abstract: OBJECTIVE
  There is a lack of knowledge concerning long-term reoperation and complications after laparoscopic sacrocolpopexy (LSCP). We analyzed the rates and indications and potential risk factors for reoperation after LSCP in a large series of consecutive patients.
  
  
  METHODS
  This was a single-center, retrospective study including all patients who underwent LSCP between 2003 and 2013. Data regarding pelvic organ prolapse (POP), surgical modalities and perioperative complications were collected. Patients were then contacted by telephone or postal letter in 2014. The main outcome criteria were grade III Dindo classification complications: reoperation for POP recurrence, mesh complications, and urinary incontinence (UI).
  
  
  RESULTS
  Between January 2003 and December 2013, a total of 464 consecutive patients (mean age, 59 years) underwent LSCP. Almost all (99.1 %) patients presented with POP ≥ grade 3 (POP-Q classification). Long-term evaluations were completed for 391 (84.1 %) patients. The median follow-up was 53.5 ± 28.2 months. The global reoperation rate was 12.5 %. The main reoperation indications were UI-related surgery in 21 patients (5.5 %), POP recurrence surgery in 20 patients (5.1 %), and mesh-related surgery in 11 patients (2.8 %). Multivariate analysis showed that older age at the time of initial surgery and concomitant subtotal hysterectomy were significant protective factors against global reoperation (HR = 0.606, CI 95 % [0.451-0.815] and 0.367, CI 95 % [0.193-0.698] respectively) and reduced the risk of POP recurrence surgery.
  
  
  CONCLUSIONS
  Prolapse recurrence and mesh-related surgery occurred in 5.1 and 2.8 % of patients respectively, 4 years after laparoscopic sacrocolpopexy. Age and concomitant subtotal hysterectomy could play a role in the incidence of long-term reoperation.
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France. vdddv@live.fr.
authors.forename: David
authors.initials: D
authors.lastname: Vandendriessche
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Sussfeld
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Giraudet
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lucot
authors.affiliation: Methodology and Biostatistics Unit, EA2694, UDSL2, University Lille Nord de France, University Hospital of Lille, Lille, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Behal
authors.affiliation: Gynecological Surgery Unit, Jeanne de Flandre Hospital, University Hospital of Lille, Lille, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Cosson
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000145:classification / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects*; D014549:Urinary Incontinence / Q000209:etiology
keywords: Complication; Laparoscopic sacrocolpopexy; Long term; Prolapse; Reoperation