Safety of laparoscopic ventral rectopexy in the elderly: results from a nationwide database.

Abstract

BACKGROUND:

Laparoscopic ventral rectopexy is an established procedure in the treatment of posterior pelvic organ prolapse. It is still unclear whether this procedure can be performed safely in the elderly.

OBJECTIVE:

This study aimed to assess the effects of age on the outcome of laparoscopic ventral rectopexy performed for patients with pelvic organ prolapse.

DESIGN:

This study was a retrospective cohort analysis with data from a national registry.

SETTINGS:

The study was conducted in a tertiary care setting.

PATIENTS:

Patients undergoing laparoscopic ventral rectopexy were identified from discharge summaries. Patients were stratified according to age, including patients <70 (group A) and ≥ 70 (group B) years old.

MAIN OUTCOME MEASURES:

Variables analyzed included sex, age, diagnosis, associated pelvic organ prolapse, comorbidities, length of stay, complications (Clavien-Dindo scale), and mortality.

RESULTS:

Among 4303 patients (98.2% women) who underwent a laparoscopic ventral rectopexy, 1263 (29.4%) were >70 years old (mean age, 76.2 ± 5.0 years). Main diagnoses were vaginal vault prolapse (53.0% [group A] vs 47.0% [group B]; p value not significant) and rectal prolapse (17.7 vs 26.8%; p value not significant). Comorbidity was significantly increased in group B (mean length of stay, 5.6 ± 3.6 vs 4.7 ± 1.8 days; p < 0.001) and minor complications (8.4% vs 5.0%; p < 0.001) were significantly increased in group B, whereas major complications were not different (group A, 0.7%; group B, 0.9%; p = 0.40) after univariate analysis. Multivariate analysis found no significant differences between groups. The subgroup analysis of patients >80 years old (n = 299) showed no differences. Each group had 1 postoperative mortality.

LIMITATIONS:

Limitations of the study include its retrospective design, lack of prestudy power calculation, possible inaccuracy of an administrative database, and selection bias.

CONCLUSIONS:

Laparoscopic ventral rectopexy appears to be safe in select elderly patients.

• Authors: Fatma A Gultekin, Mark T C Wong, Juliette Podevin, Marie-Line Barussaud, Myriam Boutami, Paul A Lehur, Guillaume Meurette
• Journal: Diseases of the colon and rectum (Dis Colon Rectum) Vol. 58 Issue 3 Pg. 339-43 (Mar 2015) ISSN: 1530-0358 [Electronic] United States
• PMID: 25664713 (Publication Type: Comparative Study, Journal Article)

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Comorbidity
• Female
• France (epidemiology)
• Humans
• Length of Stay
• Male
• Middle Aged
• Multivariate Analysis
• Pelvic Organ Prolapse (diagnosis, epidemiology, surgery)
• Postoperative Complications (classification, epidemiology)
• Proctoscopy (adverse effects, methods, mortality)
• Rectal Prolapse (diagnosis, epidemiology, surgery)
• Rectum (physiopathology, surgery)
• Retrospective Studies
• Risk Assessment