Day case transobturator tapes: a cut and dried solution

Abstract

The transobturator tape (TOT) has been utilized in the surgical management of SUI since 2001 when it was first described and is associated with minimal risk of trauma as its purely perineal insertion avoids entry to the retropubic space. Given its high success rate, low associated peri-operative morbidity and relative ease of insertion, it has been increasingly used as a day case procedure worldwide. This study aims to demonstrate the suitability of the transobturator tape (TOT) as a day surgery procedure in the Republic of Ireland. A retrospective review of all the patients who underwent TOT as a day case procedure at a tertiary referral centre in Dublin over a 1year period (March 2015-March 2016) was carried out. This was post the introduction of the procedure as a day case for a select group of patients. The outcomes evaluated included intraoperative and postoperative complication rates, voiding dysfunction rates, unscheduled inpatient admissions following the procedure and continence rates post-procedure. Fifteen cases were reviewed. There was one case with minor intraoperative complication of bladder perforation which was managed as an outpatient. One patient (6%) failed to achieve adequate voiding within the 6-h timeframe allowed and, therefore, required overnight admission. All patients reported dryness at the 6-week review. Major elective waiting time for the gynaecology list decreased from 28 to 10weeks 1year post-commencement of the protocol. We conclude that the transobturator tape procedure is suitable as a day case in a select group of patients in the Irish healthcare setting. There was no increased rate of morbidity demonstrated in the group and readmission rates were low. It has reduced waiting times by increasing throughput of cases and ultimately will lead to reduced costs for hospitals.