Our main objective was to know the incidence of severe anemia after subtotal hysterectomy and laparoscopic sacrocervicocolpopexy in uterine prolapse surgery and to analyze the relationship of this outcome with the risk of surgical recurrence. 

As secondary aims we analyzed the incidence of blood transfusions in this surgery and the preoperative and intraoperative factors that could be related  with postoperative anemia.

The study design is an observational analytical retrospective cohort study of 92 patients operated for correction of uterine prolapse by laparoscopic subtotal hysterectomy and sacrocervicocolpopexy with SERATEX E9 mesh.

To collect the information of the study a review of clinical histories was employed. 

The following variables were included: 
Main outcome variables: (1) postoperative anemia with two cut-off points: postoperative hemoglobin < 10 g/dL or a grade of anemization ≥ 2,5 g/dL between pre and postoperative hemoglobin levels. (2) Incidence of postoperative blood cell transfusion. (3) Incidence of surgical recurrence, defined as symptomatic prolapse that requires a new surgical technique.

The selected independent variables studied as potential risk factors were, preoperative: patient age, menopause, body mass index (BMI), weigh, number of births, smoke, hypertensive treatment, respiratory disease (Asthma, chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea syndrome (OSAS)),  history of assisted vaginal birth or twin vaginal birth, history of cesarean section, history of abdominal surgeries, history of vaginal surgeries, uterine diameter, presence of myomas, preoperative anesthetic risk assessment by the American society of anesthesiologist classification (ASA),  experience of the surgical team and adnexectomy or salpingectomy. 

The intraoperative variables selected were: intraoperative blood loss describe in the surgical report, urological or digestive incidental injuries during surgery, the use of uterine manipulator, the use of peritoneal tunneler, surgical anesthetic preparation longer than 30 minutes, surgical delay longer than 30 minutes over the media of the surgical team, intraoperative respiratory complications, intraoperative change of the surgical technique. 

The data analysis was performed using the Stata program, version 18.0. Categorical variables are expressed as absolute and relative frequencies and were analyzed using the chi-square test. Continuous variables are expressed as the mean and standard deviation. Differences between the two groups were compared using Student t test. Non parametric variables are expressed as medians and interquartile ranges (IQRs), and significance was determined using the Mann-Withney U test. P ≤ 0,05 was considered statistically significant.

The study population was 92 patients with symptomatic prolapse operated in our center between September 2018 and October 2023.

The demographic characteristics of the group were a median age of 55 years, median weigh of 66,8 Kg, a median body mass index of 26,2 Kg/ m2 and a 65% (60) of postmenopausal patients.

Regarding the incidence of postoperative severe anemia just a 5,4% (5) had a postoperative hemoglobin < 10 g/dL and adding to this group those patients with a decrease of hemoglobin between preoperative and postoperative ≥ 2,5 g/dL a total of 24,7% (23) patients were selected for the risk factor analysis.

The incidence of intra or postoperative blood cell transfusion was 0%.  The incidence of surgical recurrence was 6,5% (6). 

We studied the relationship between postoperative anemia with potential risk factors, and a statistical association was found (p ≤ 0,05) only for the preoperative hemoglobin level. No association was found for postoperative anemia and the rest of the preoperative or intraoperative factors described in the series. (Tables 1 and 2)

The analysis of the relationship between postoperative anemia and the risk of surgical recurrence demonstrated that postoperative anemia is not related to an increase of postoperative surgical recurrence. 

The analysis of risk of recurrence was done with two different postoperative anemia criteria: the first analysis demonstrated that a hemoglobin level < 10g/dL hasn´t got statistical association with recurrence. The second analysis add to that first group all patients with a decrease of hemoglobin between pre and postoperative ≥  2,5 g/dL and in this second group we didn´t demonstrated any statistical association. (Tables 3 and 4)

Sacrocervicocolpopexy after subtotal hysterectomy as surgery for uterine prolapse has a very low risk of severe postoperative anemia and intra or postoperative need of blood cell transfusion. 

In our series severe postoperative anemia or a big anemization due to the surgery didn’t demonstrate a higher rate of surgical recurrence. 

In our univariant analysis the preoperative anemia was the only independent factor associated with postoperative anemia (p = 0,028).

Laparoscopic subtotal hysterectomy and sacrocervicocolpopexy with mesh has a very low risk of severe postoperative anemia and very low rate of intra or  postoperative blood cell transfusion. The postoperative anemia is not related to surgical recurrence.