Impact of Weight Loss Surgery on Complications After Subsequent Prolapse Surgery

Objectives: Obesity is a risk factor for pelvic organ prolapse (POP) and independently associated with perioperative complications following prolapse surgery. While bariatric surgery may lead to weight loss and mitigate obesity-related comorbidities, it is associated with chronic malabsorption, which may impair post-operative healing. There have been no previous studies to evaluate the impact of prior weight loss surgery (WLS) on POP surgery outcomes. This study aims to describe the effect of WLS on complications after POP surgery.

Methods: This was a retrospective cohort analysis of patients who underwent WLS prior to surgery for POP. Data was procured from a U.S. National Database between January 2000 and March 2020 using Current Procedural Terminology codes. Comparisons were made between patients with and without a history of WLS.

Results: Of 22,363 surgeries performed for POP, 542 (2.43%) previously underwent WLS with a median interval time of 30 months (IQR 15-51). The WLS group was significantly younger, had a lower Charlson comorbidity score, and had higher rates of class II or III obesity (p < 0.001), and were less likely to undergo obliterative procedures (0.74% vs 2.9%, p=0.0038). The WLS group had higher rates of anemia (17% vs 9.4%, p < 0.001), dumping syndrome (1.3% vs 0.049%, p< 0.001), and malabsorption (12% vs 0.44%, p< 0.001). Between groups, there was no significant difference in rates of hysterectomy, sacrocolpopexy, or sling at time of POP surgery.

The WLS group had higher rates of mesh erosion at 3 months (3% vs 1.5%, p=0.0079) and 12 months postoperatively (3.1% vs 1.8%, p=0.04) and had higher rates of hematoma (1.7% vs 0.68%, p=0.014). Among patients who had WLS greater than or less than 2 years prior to POP surgery, there was no difference in the rates of mesh erosion and hematoma. There was no significant difference in rates of surgical site infection between patients with and without prior WLS.

Conclusions: A history of prior weight loss surgery was associated with increased rates of mesh erosion and hematoma after surgery for pelvic organ prolapse.