Faster Recuperation May Hinder Laparoscopic Burch Outcomes.

VAIL, COLO. -- One of the touted advantages of laparoscopic Burch procedures for stress incontinence--faster recuperation--may in fact be a detriment, according to Dr. Nicollete S. Horbach, immediate past president of the American Urogynecologic Society.

"If you think about it, what we as reconstructive surgeons do is tissue repair. We do antigravity surgery--and gravity is not your friend postoperatively," she cautioned at a conference on obstetrics and gynecology sponsored by the University of Colorado.

"We know from wound studies that it takes about 3 months for a patient to be only 80% healed. So if you allow that postlaparoscopic Burch patient to return to normal activities because she feels great a week or two postop, you have not necessarily given that tissue adequate time. Unless you've gotten really good, strong bites in that tissue, she's going to start doing something and suddenly--as they many times report--she'll feel that 'pop,' and the incontinence returns," said Dr. Horbach of George Washington University, Washington.

Abdominal retropubic urethropexy via either the Burch procedure or the Marshall-Marchetti-Krantz (MMK) procedure is the operation of choice for women with genuine stress incontinence due to a hypermobile urethrovesical junction in the presence of a normally functioning urethral sphincter.

Long-term success rates with the open Burch and MMK procedures are comparable: roughly 80% at 5-10 years. A surgeon's preference is mostly a matter of training, along with one's comfort level with the different types of complications.

The major problem with the MMK procedure is ...