Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes

Abstract

Background: Uterovaginal prolapse in very elderly women is a growing problem due to increased life expectancy. Surgeons and anaesthetists may be wary of performing quality of life surgery on this higher risk group. Where surgery is undertaken, it is commonly performed vaginally; there is a perception that this is better tolerated than abdominal surgery. Little data is published about laparoscopic prolapse surgery tolerability in this population, and laparoscopic surgery is perceived within the urogynaecological community as complex and lengthy and hence inherently unsuitable for the very elderly. In Oxford, UK, laparoscopic abdominal surgical techniques are routinely employed for urogynaecological reconstructive surgery. The authors offer abdominal laparoscopic prolapse surgery to patients suitable for general anaesthesia with apical vaginal prolapse, irrespective of age. We here report outcomes in this elderly patient cohort and hypothesise these to be acceptable. This is a retrospective case note review of all patients aged 79 years old and above undergoing laparoscopic prolapse surgery (hysteropexy or sacrocolpopexy) in two centres in Oxford, UK, over a 5-year period (n = 55). Data were collected on length of surgery, length of stay, intraoperative complications, early and late post-operative complications and surgical outcome.

Results: Mean age was 82.6 years (range 79-96). There were no deaths. Minor post-operative complications such as UTI and constipation were frequent, but there were no serious (Clavien-Dindo grade III or above) complications; 80% achieved objective good anatomical outcome.

Conclusions: Laparoscopic prolapse surgery appears well tolerated in the elderly with low operative morbidity and mortality.

Keywords: Elderly; Hysteropexy; Laparoscopic; Prolapse; Sacrocolpopexy.