Perioperative Complications: The First 140 Polypropylene Pubovaginal Slings

Abstract

Two widely used tensionless mid urethral slings currently available are the SPARC polypropylene sling (American Medical Systems, Minneapolis, Minnesota) and the TVT (tensionless vaginal tape, Ethicon, New Brunswick, New Jersey). As with the TVT system, the SPARC 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 patients overnight following the SPARC sling be considered. We retrospectively reviewed the charts of the first 140 patients who received the SPARC polypropylene pubovaginal sling at our institution to evaluate for early complications requiring intervention. Because we wished to evaluate for occult bleeding, we checked the hematocrit on postoperative day 1 in the last 57 patients regardless of blood loss in the operating room. A total of 6 patients required intervention in the early postoperative period, including transfusion in 4 immediately postoperatively for retropubic bleeding. One patient had presented with pelvic pain and vaginal bleeding 1 week postoperatively and was found to have a large retropubic hematoma that required percutaneous drainage. The final patient 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 blood loss in this group of 170 cc (range less than 50 to 700). We recommend caution with any patient who receives a sling that requires passage of needles through the retropubic space, which can result in occult retropubic bleeding, 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 SPARC as an excellent sling option but we caution surgeons of the potential complications and urge careful postoperative monitoring. We recommend that SPARC not routinely be considered as an outpatient procedure.