Perioperative complications: the first 140 XXXX pubovaginal slings.

@entity1 @entity9618 @entity548 @entity190 @entity7502 @entity1410 @entity158
PURPOSE: Two widely used tensionless mid urethral slings currently available are the @entity9618 @entity7502 sling (American Medical Systems, Minneapolis, Minnesota) and the TVT (tensionless vaginal tape, Ethicon, New Brunswick, New Jersey). As with the TVT system, the @entity9618 has been suggested as an outpatient procedure. We present the early complications of our first 140 slings, based on which we recommend that observation of all @entity1 overnight following the @entity9618 sling be considered. MATERIALS AND METHODS: We retrospectively reviewed the charts of the first 140 @entity1 who received the @entity9618 @entity7502 pubovaginal sling at our institution to evaluate for early complications requiring intervention. Because we wished to evaluate for @entity548 , we checked the hematocrit on postoperative day 1 in the last 57 @entity1 regardless of @entity190 in the operating room. RESULTS: A total of 6 @entity1 required intervention in the early postoperative period, including transfusion in 4 immediately postoperatively for @entity548 . One @entity1 had presented with pelvic @entity158 1 week postoperatively and was found to have a large retropubic @entity1410 that required percutaneous drainage. The final @entity1 was discharged home on postoperative day 1 in stable condition but presented on postoperative day 4 with drainage from a suprapubic incision. She had a perforation through a loop of small bowel that required resection of a short segment of the bowel and removal of the sling. The mean decrease in hematocrit from preoperative to postoperative day 1 was 7.1% (range 1% to 14%) despite a mean intraoperative @entity190 in this group of 170 cc (range less than 50 to 700). CONCLUSIONS: We recommend caution with any @entity1 who receives a sling that requires passage of needles through the retropubic space, which can result in occult @entity548 , and dilation of the tract. While visceral injury is exceedingly rare, it must be discussed as a possible risk of the surgery. We continue to advocate @entity9618 as an excellent sling option but we caution surgeons of the potential complications and urge careful postoperative monitoring. We recommend that @entity9618 not routinely be considered as an outpatient procedure.
