Analysis of hidden blood loss and its risk factors in pelvic floor prolapse surgeryusingthe vaginal sacrospinous ligament suspension and laparoscopic uterosacral approaches

Abstract

Abstract Aim: To investigate the risk factors of hidden blood loss(HBL)in the treatment of patients with pelvic floor prolapse. Methods: This study enrolled 132 patients who had undergone either vaginal total hysterectomyand sacrospinous ligament fixation (Group1) or laparoscopic total hysterectomy and laparoscopic high uterosacral ligament suspension(Group2)from January 1, 2017, to December 31, 2020. The patients’ demographic and perioperative characteristics were compared, and the risk factors for HBL were assessedusing logistic regression. Results:Compared with the Group 2, the Group 1 had a longer duration of menopause, shorter surgical time, and lower hospitalization costs.. Furthermore, Group 1 mostly comprised severe prolapse cases and had greater total blood loss(TBL)and HBL. Intraoperative bleeding, postoperative hematocrit, surgical approach, menopausal age, and menopausaltimewere independent risk factors for HBL. Conclusion: Sacrospinous ligament fixation（SSLF）is safe, effective, and convenient;itallows for a rapid recovery and is especially suitable for patients with severe prolapse.Therefore, this procedure should be used more widely. In addition, patients’ demographic characteristics and blood parameters must be considered when selecting the most appropriate surgical approach for each patient. Furthermore , HBL may be severely underestimated, which can affect patient’s prognosis, intraoperative surgeries should be carefully performed to reduce intraoperative HBL, thus ensuring that patients safely survive the postoperative stage.