Reloadable Stapler Use during Peripartum Hysterectomy for Placenta Accreta Spectrum: A Novel Surgical Technique and Case Series

Abstract

Objective This study aimed to describe a novel surgical technique for the management of antenatally suspected placenta accreta spectrum (PAS).

Study Design This is a retrospective, case series of patients with suspected PAS undergoing peripartum hysterectomy with a reloadable articulating stapler at a tertiary care center.

Results Eighteen patients with antenatally suspected PAS were identified and underwent peripartum hysterectomy with the aid of a reloadable stapler. Mean gestational age at delivery was 34^4/7 ± 1^1/7 weeks. Mean total operative time (skin-to-skin) was 117.3 ± 39.3 minutes, and 79.8 ± 19.8 minutes for the hysterectomy. Mean blood loss for the entire case was 1,809 ± 868 mL. Mean blood loss for the hysterectomy was 431 ± 421 mL. Mean units of intraoperative red blood cells transfused was 3 ± 1 units. Mean units of postoperative red blood cells transfused was 1 ± 0.5 units. Five cases were complicated by urological injury (two intentional cystotomies). Four patients were admitted to the intensive care unit (ICU) for a mean of ≤24 hours. Mean postoperative LOS was 4.11 ± 1.45 days. Three patients had final pathology that did not demonstrate PAS while four were consistent with accreta, six increta, and five percreta.

Conclusion Use of a reloadable articulating stapler device as part of the surgical management of antenatally suspected PAS results in a shorter operative time (117 ± 39 minutes vs. 140–254 minutes previously reported), lower average blood loss (1,809 ± 868 mL vs. 2,500–5,000 mL previously reported) and shorter LOS (4.11 ± 1.45 days vs. 9.8 ± 13.5 days previously reported) compared with traditional cesarean hysterectomy. The reloadable stapling device offers an advantage of more rapidly achieving hemostasis in the surgical management of PAS.

Key Points

• PAS is associated with severe maternal morbidity.

• Decreased operative time and blood loss have many clinical benefits.

• Reloadable stapler use for PAS decreases operative time.

• Reloadable stapler use for PAS decreases operative blood loss.

Keywords

hysterectomy - reloadable stapler - placenta accreta spectrum

Publication History

Received: 03 June 2020

Accepted: 07 July 2020

Article published online:
20 August 2020

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