Influence of the type of anesthesia and hydrodissection on the complication rate after tension-free vaginal tape procedure

Objective: To evaluate the success rate of tension-tree vaginal tape (TVT) performed under spinal and general anesthesia and to asses, the efficacy of hydrodissection of the space of Retzius in reducing intraoperative and postoperative complications. Study Design: A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the space of Retzius, that was performed only in 82 cases. In the remaining 67 patients the TVT needles were introduced directly without hydrodissection. Postoperatively, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure was defined as no postoperative stress incontinence. Results: Overall, the incidence of intraoperative and postoperative complications was 3.3% and 14.7%, respectively. No statistical difference was found in the intraoperative (1.9% versus 4.2%, P = 0.65) and postoperative complications (11.3% versus 16.7%) rates between the general and spinal anesthesia groups. No difference was found in the cure rate between groups (96.2% versus 95.8%). Similarly, no difference was found in the rate of intraoperative (3.7% versus 3.0%) and postoperative (15.9% versus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT placement without concomitant surgery (n = 88), there was no difference in the incidence of intraoperative (2.1% versus 5.0%, P = 0.59) and postoperative complications (14.6% versus 15.0%, P = 1.0) between patients who had hydrodissection and those who did not. Conclusions: Efficacy and safety of the TVT procedure are not affected by the type of anesthesia (general or loco-regional). Hydrodissection of the space of Retzius during TVT placement does not reduce the risks of intraoperative complications. (C) 2004 Elsevier Ireland Ltd. All rights reserved.