Perioperative hemorrhagic complications in pelvic floor reconstructive surgery.

INTRODUCTION AND HYPOTHESIS: We sought to assess the incidence, symptoms, and risk factors of perioperative hemorrhagic complications in patients undergoing pelvic floor reconstructive surgery.

METHODS: This is a retrospective study on 694 consecutive patients who underwent pelvic floor reconstructive surgery with or without using mesh in our hospital over a 3-year period.

RESULTS: We identified 694 pelvic floor reconstructive procedures from 2014 to 2016, including complete/incomplete colpocleisis (176, 25.4%), sacral colpopexy/hysteropexy with mesh (140, 20.1%), colporrhaphy (77, 11.1%) or vaginal mesh repair (99, 43.1%). Two patients who received only sacrospinous ligament suspension were excluded. There were 68 (9.8%) and 3 (0.1%) patients whose blood loss reached 200 and 500 ml respectively. Procedures involving mesh and vaginal hysterectomy (VH) caused more intraoperative blood loss. Postoperative hemoglobin drop was least in colpocleisis (p < 0.05). All 6 of the patients (0.9%) who developed postoperative pelvic hematoma underwent concomitant VH, and 5 of them received mesh.

CONCLUSIONS: Hemorrhagic complications during or after pelvic floor reconstructive surgery are rare. Mesh use and concomitant VH are two major surgical risk factors for hemorrhagic complications in pelvic floor reconstructive surgery.