A REVIEW OF RESULTS IN A SERIES OF 113 LAPAROSCOPIC COLPOSUSPENSIONS

The case records of 113 women having laparoscopic retropubic colposusp ensions (Burch procedure) performed for the treatment of genuine urina ry stress incontinence between December, 1992 and April, 1995 were ret rospectively reviewed. The mean age of the group was 49.4 (30-80) year s, mean weight 72.1 (44.5-114) kg, and mean parity 2.7 (0-8). All pati ents had preoperative urodynamic study to confirm genuine stress incon tinence (GSI). Sixteen patients (14%) had dual pathology (GSI and detr usor instability). A transperitoneal approach was used in 93 operation s and extraperitoneal in 20. The mean operating time was 108 (30-320) minutes and mean hospitalization 3.3 (1-10) days. In 13 women the oper ation was converted to laparotomy; 10 due to adhesions and diminished bladder mobility, 1 for inferior epigastric vessel injury, 1 for an ov arian tumour discovered incidentally at the procedure and 1 for equipm ent problems. Operative complications included 10 cystotomies (5 repai red laparoscopically), 2 extraperitoneal cases converted to transperit oneal, 1 inferior epigastric vessel injury, 1 vaginal tear, 1 suture t hrough the bladder and 1 case of possible enterotomy oversewn at lapar oscopy. The mean follow-up period was 8.4 (1-28) months. All patients were reviewed postoperatively and then contact was attempted either by telephone or in consultation. There was an overall 87% subjective suc cess rate. Two patients felt sutures tear out at 4 and 6 months and we re deemed failures; 4 felt their incontinence was improved but had ong oing stress incontinence of urine; 9 had symptoms of detrusor instabil ity and one developed an enterocele 9 months after surgery.