BLEEDING COMPLICATIONS WITH THE TENSION-FREE VAGINAL TAPE (TVT) OPERATION

K. Tamussino, E. Hanzal, D. Kölle, O. Preyer, G. Ralph, P. Riss, and A. Tammaa for the

Austrian Urogynecology Working Group

Medical University of Graz, Graz, Austria

OBJECTIVE: To analyze intraoperative and postoperative bleeding problems with Tension-free Vaginal Tape (TVT, Gynecare, Ethicon) operations in the Austrian Vaginal Tape Registry.

MATERIALS AND METHODS: We identified patients for whom increased intraoperative bleeding or reoperation for bleeding/hematoma with the TVT operation were reported to the Registry. The participating centers reporting these operations were contacted to obtain details on the nature and management of the bleeding problem and transfusion requirements. Bleeding problems clearly due to concomitant operations such as hysterectomy were excluded.

RESULTS: Bleeding problems were reported for 147 of 5578 (2.6%) TVT operations. Increased intraoperative bleeding was reported for 106 (1.9%) operations and reoperation (or conversion) in 44 (0.8%) patients (both in 3 patients). Increased intraoperative bleeding was managed conservatively (i.e., compression, tamponade) in 103 of 106 patients. Only 3 of 106 patients with increased intraoperative bleeding required conversion to laparotomy. Eleven patients with reported increased intraoperative bleeding developed hematomas that were managed expectantly (as did an additional 3 patients).  Overall, 44 (0.8%) patients required conversion or reoperation for bleeding or hematoma; details are available for 28 of these operations. Among these 28 patients, 24 underwent laparotomy, 3 had bleeding from a suprapubic catheter site, and 1 bleeding from the vaginal incision. The source of bleeding was considered arterial in 14% (including 1 injury of the left external iliac artery and 1 injury of a left obturator artery) and venous or unknown in 86%. Of the 28 reoperated patients for whom details are available, 14 (50%) were reoperated within 24 hours, 5 (18%) within 2-10 days, and 9 (32%) within 11 and 35 days after TVT placement. 16 of the 28 reoperated or converted patients received RBC transfusions (median, 2; range, 0-10 units). There were no deaths from bleeding complications.

CONCLUSIONS: Bleeding complications were reported with less than 3% of 5578 TVT operations, with 0.8% of patients requiring reoperation or conversion. Most cases of increased intraoperative bleeding were managed expectantly.

Key Words: stress incontinence, surgery, Tension-free vaginal tape, bleeding, complications

Disclosure - Speakers Bureau: K. Tamussino, Gynecare, Lilly.