Effects of Low Intraperitoneal Pressure on Quality of Postoperative Recovery after Laparoscopic Surgery for Genital Prolapse in Elderly Patients Aged 75 Years or Older

Study Objective: Previous clinical trials for laparoscopic surgery have included few elderly patients aged >= 75 years. We aimed to evaluate the quality of postoperative recovery after laparoscopic surgery using low intraperitoneal pressure (IPP) (6 mm Hg) and warmed, humidified carbon dioxide gas for genital prolapse in elderly patients aged >= 75 years.Design: Prospective consecutive case series.Setting: University hospital.Patients: Consecutive patients (n = 30) aged >= 75 years planning to undergo laparoscopic surgery for genital prolapse by the same surgeon were recruited from October 2016 through December 2019.Interventions: Laparoscopic promontofixation for the treatment of genital prolapse was performed using low IPP and warmed, humidified carbon dioxide gas. When a promontory could not be easily identified, laparoscopic pectopexy was alternatively performed.Measurements and Main Results: The primary outcome was the Quality of Recovery- 40 (QoR-40) score at 24 hours postoperatively. The secondary outcomes were postoperative pain using a 100-mm visual analog scale and the length of hospital stay after surgery (LHSS). For the global QoR-40 score and for 4 dimensions of the QoR-40, "emotional state," "physical comfort," "psychologic support," and "pain," no differences were observed between the baseline score and the score at 24 hours. The score for the "physical independence" dimension at 24 hours was significantly lower than the baseline score (p<.001). No patient had visual analog scale pain scores > 30 out of 100 at 12 hours or later. LHSS was < 48 hours in 22 patients (73.3%) and < 72 hours in 8 patients (26.7%). Multivariable analysis showed that the odds of an LHSS > 48 hours were more than 8 times higher in patients who were discharged from the operating room in the afternoon compared with those with a morning discharge.Conclusion: The use of a low IPP is feasible, safe, and has clinical benefits for elderly patients aged >= 75 years who undergo laparoscopic surgery for genital prolapse. (C) 2020 AAGL. All rights reserved.