Skip to main content

Advertisement

SpringerLink
Log in

Obesity and its long-term impact on sacrocolpopexy key outcomes (OBELISK)

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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

  2. 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.

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  CAS  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. 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.

Download references

Funding

The study was funded by National Sustainability Program I (NPU I) No. LO1503 and Charles University Research Fund (Progress Q39).

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Hospital, Pilsen, Czech Republic

    Martin Smazinka, Vladimir Kalis, Martin Havir & Zdenek Rusavy

  2. Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic

    Vladimir Kalis, Khaled M. Ismail & Zdenek Rusavy

  3. New Technologies-Research Centre, University of West Bohemia, Pilsen, Czech Republic

    Linda Havelkova

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

    Khaled M. Ismail

Authors
  1. Martin Smazinka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vladimir Kalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Havir
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Linda Havelkova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khaled M. Ismail
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zdenek Rusavy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Khaled M. Ismail.

Ethics declarations

Conflicts of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Martin Smazinka and Vladimir Kalis are joint first authors.

Electronic supplementary material

ESM 1

(DOCX 71 kb)

ESM 2

(DOC 84 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Smazinka, M., Kalis, V., Havir, M. et al. Obesity and its long-term impact on sacrocolpopexy key outcomes (OBELISK). Int Urogynecol J 31, 1655–1662 (2020). https://doi.org/10.1007/s00192-019-04076-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-019-04076-8

Keywords

Search

Navigation