title: Obliterative Versus Reconstructive Prolapse Repair for Women Older than 70: Is There an Optimal Approach?
abstract: This study aimed to evaluate outcomes among women 70 years and older who underwent obliterative compared with reconstructive procedures for pelvic organ prolapse.
  
  
  
  This was a retrospective cohort study of patients 70 years and older who underwent surgical prolapse repair at our institution from January 2004 through June 2010. Only patients with at least 4 weeks of follow-up were included. Patient characteristics and relevant pre, intra, and postoperative information were abstracted from medical records. Severity of postoperative complications was classified using the Dindo surgical classification system.
  
  
  
  We analyzed 143 (97.3%) patients. Fifty-four (37.8%) women underwent an obliterative procedure, whereas 89 (62.2%) underwent a reconstructive procedure. Twenty-eight (31.5%) women who had a reconstructive surgery met our criteria for recurrent prolapse compared with only 5 (9.3%) women in the obliterative group (P = 0.002).The incidence of intraoperative complication was 4.9%, and the incidence of any postoperative complication was 62.9%. Similar proportions of women who underwent each type of procedure experienced a postoperative complication. However, the severity of the complications differed between the groups (P = 0.02). In particular, 16.9% of women who had a reconstructive procedure experienced a grade III complication according to the Dindo scale compared with 13.0% of women who had an obliterative procedure.
  
  
  
  The majority of women 70 years and older do not have high-grade complications after pelvic organ prolapse repair, but women who undergo reconstructive procedures are more likely to experience high-grade complications and recurrent prolapse compared with women who undergo obliterative procedures.
authors: From the *Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge; †Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center; and ‡Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors: Sybil G
authors: SG
authors: Dessie
authors: Alex
authors: A
authors: Shapiro
authors: Miriam J
authors: MJ
authors: Haviland
authors: Michele R
authors: MR
authors: Hacker
authors: Eman A
authors: EA
authors: Elkadry
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000145:classification; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000145:classification; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013526:Surgical Mesh / Q000009:adverse effects; D016896:Treatment Outcome