INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy is the preferred contemporary approach to managing significant apical pelvic organ prolapse. Obesity is an established risk factor for several surgical procedures and can have a negative impact on outcomes. Our goal was to evaluate the impact of BMI on the safety and efficacy of laparoscopic sacrocolpopexy in women with pelvic organ prolapse. METHODS: A single-center retrospective observational study of women undergoing laparoscopic sacrocolpopexy between January 1, 2015, and December 31, 2017. RESULTS: We found 299 procedures: 82 (27.4%), 147 (49.2%) and 70 (23.4%) in women with BMI <25 (normal weight), BMI ≥ 25 - < 30 (overweight) and BMI ≥ 30 (obese), respectively. Perioperative and early postoperative complications were generally low and not statistically significantly different between the groups. At 12 months postoperatively, 81 (98.8%), 136 (92.5%) and 62 (88.6%) normal-weight, overweight and obese women attended their follow-up, respectively. All obese women attending the follow-up scored an overall Patient Global Impression of Improvement (PGI-I) of ≤ 3. The Pelvic Floor Distress Inventory (PFDI) scores showed a significant improvement in all domains and were similar between the study groups. In total, there was one (0.4%) anatomical apical compartment failure, three (1.1%) anterior compartment failures and two (0.7%) posterior compartment failures with no significant differences between the groups. Similarly, there were no differences in functional outcomes or mesh position as assessed by ultrasound. CONCLUSIONS: There were no differences in surgical, short- and long-term outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse in obese compared with non-obese women.

Biomedical Center Faculty of Medicine in Pilsen Charles University Pilsen Czech Republic

Department of Gynecology and Obstetrics Faculty of Medicine in Pilsen Charles University alej Svobody 76 304 60 Pilsen Czech Republic

Department of Gynecology and Obstetrics University Hospital Pilsen Czech Republic

New Technologies Research Centre University of West Bohemia Pilsen Czech Republic

Zobrazit více v PubMed

Engin A. (2017) The definition and prevalence of obesity and metabolic syndrome. In: Engin A., Engin A. (eds) Obesity and lipotoxicity. Adv Exp Med Biol, vol 960. Springer, Cham

Vidra N, Bijlsma MJ, Trias-Llimós S, Janssen F. Past trends in obesity-attributable mortality in eight European countries: an application of age–period–cohort analysis. Int J Public Health. 2018. https://doi.org/10.1007/s00038-018-1126-2 .

Bradley CS, Kenton KS, Richter HE, et al. Obesity and outcomes after sacrocolpopexy. Am J Obstet Gynecol. 2008;199:690.e1–8. https://doi.org/10.1016/j.ajog.2008.07.030 . DOI

Halder GE, Salemi JL, Hart S, Mikhail E. Association between obesity and perioperative morbidity in open versus laparoscopic sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2017;23:146–50. https://doi.org/10.1097/SPV.0000000000000382 . PubMed DOI

Haylen BT, Maher CF, Barber MD, et al. Erratum to: an International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27:655–84. https://doi.org/10.1007/s00192-016-3003-y . PubMed DOI

Weber AM, Abrams P, Brubaker L, et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:178–86. https://doi.org/10.1007/PL00004033 . PubMed DOI PMC

Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013;24:1783–90. https://doi.org/10.1007/s00192-013-2169-9 . PubMed DOI

Augusto KL, Bezerra LRPS, Murad-Regadas SM, et al. Defecatory dysfunction and fecal incontinence in women with or without posterior vaginal wall prolapse as measured by pelvic organ prolapse quantification (POP-Q). Eur J Obstet Gynecol Reprod Biol. 2017;214:50–5. https://doi.org/10.1016/j.ejogrb.2017.04.039 . PubMed DOI

Giri A, Hartmann KE, Hellwege JN, et al. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217:11–26.e3. https://doi.org/10.1016/j.ajog.2017.01.039 . PubMed DOI

Dieter AA, Edenfield AL, Weidner AC, Siddiqui NY. How does site of pelvic organ prolapse repair affect overactive bladder symptoms? Female Pelvic Med Reconstr Surg. 2014;20:203–7. https://doi.org/10.1097/SPV.0000000000000087 . PubMed DOI

Lowenstein L, Gamble T, Deniseiko Sanses TV, et al. Sexual function is related to body image perception in women with pelvic organ prolapse. J Sex Med. 2009;6:2286–91. https://doi.org/10.1111/j.1743-6109.2009.01329.x . PubMed DOI

Espuña-Pons M, Fillol M, Pascual MA, et al. Pelvic floor symptoms and severity of pelvic organ prolapse in women seeking care for pelvic floor problems. Eur J Obstet Gynecol Reprod Biol. 2014;177:141–5. https://doi.org/10.1016/j.ejogrb.2014.03.050 . PubMed DOI

Bilgic D, Gokyildiz S, Kizilkaya Beji N, et al. Quality of life and sexual functıon in obese women with pelvic floor dysfunction. Women Health. 2019;59:101–13. https://doi.org/10.1080/03630242.2018.1492497 . PubMed DOI

Whitcomb EL, Lukacz ES, Lawrence JM, et al. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J. 2009;20:289–94. https://doi.org/10.1007/s00192-008-0765-x . DOI

Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. In: Maher C, editor. Cochrane database of systematic reviews. Chichester: Wiley; 2013.

Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24:1815–33. https://doi.org/10.1007/s00192-013-2172-1 . PubMed DOI

Costantini E, Brubaker L, Cervigni M, et al. Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations. Eur J Obstet Gynecol Reprod Biol. 2016;205:60–5. https://doi.org/10.1016/j.ejogrb.2016.07.503 . PubMed DOI

De Gouveia De Sa M, Claydon LS, Whitlow B, Dolcet Artahona MA. Laparoscopic versus open sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis. Int Urogynecol J. 2016;27:3–17. https://doi.org/10.1007/s00192-015-2765-y . PubMed DOI

Barber MD, Kuchibhatla MN, Pieper CF, Bump RC. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–95. https://doi.org/10.1067/mob.2001.118659 . PubMed DOI

Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5 . PubMed DOI

Haylen BT, Freeman RM, Swift SE, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Int Urogynecol J. 2011;22:3–15. https://doi.org/10.1007/s00192-010-1324-9 . PubMed DOI

Gutman RE, Rardin CR, Sokol ER, et al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: a parallel cohort study. Am J Obstet Gynecol 2017;216:38.e1–11.

Dietz HP, Haylen BT, Broome J. Ultrasound in the quantification of female pelvic organ prolapse. Ultrasound Obstet Gynecol. 2001;18:511–4. https://doi.org/10.1046/j.0960-7692.2001.00494.x . PubMed DOI

Wong V, Guzman Rojas R, Shek KL, et al. Laparoscopic sacrocolpopexy: how low does the mesh go? Ultrasound Obstet Gynecol. 2017;49:404–8. https://doi.org/10.1002/uog.15882 . PubMed DOI

Svabík K, Martan A, Masata J, et al. Ultrasound appearances after mesh implantation—evidence of mesh contraction or folding? Int Urogynecol J. 2011;22:529–33. https://doi.org/10.1007/s00192-010-1308-9 . PubMed DOI

Dindo D, Demartines N, Clavien P-A. Classification of surgical complications. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae . PubMed DOI PMC

Turner L, Lavelle E, Lowder JL, Shepherd JP. The impact of obesity on intraoperative complications and prolapse recurrence after minimally invasive sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22:317–23. https://doi.org/10.1097/SPV.0000000000000278 . PubMed DOI

Thubert T, Naveau A, Letohic A, et al. Outcomes and feasibility of laparoscopic sacrocolpopexy among obese versus non-obese women. Int J Gynecol Obstet. 2013;120:49–52. https://doi.org/10.1016/j.ijgo.2012.07.020 . DOI

Mahoney C, Scott G, Dwyer L, et al. Laparoscopic sacrocolpopexy posthysterectomy: intraoperative feasibility and safety in obese women compared with women of normal weight. Int Urogynecol J. 2019. https://doi.org/10.1007/s00192-019-03888-y .

Rectocervical Fistula Repair After Laparoscopic Supracervical Hysterectomy and Laparoscopic Sacrocervicopexy

Pilsner Modification of Mesh Sacrohysterocolpopexy (PiMMS): An Initial Report on Safety and Efficacy

A Comprehensive Evaluation of Sexual Life in Women After Laparoscopic Sacrocolpopexy using PISQ-IR

Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study)

Pelvic organ prolapse and uterine preservation: a survey of female gynecologists (POP-UP survey)