Follow up of SAC technique for PAS
Research type
Research Study
Full title
A questionnaire study to assess long term morbidity following the use of the the Soleymani-Alazzam-Collins (SAC) Technique for the management of placenta accreta spectrum(PAS)
IRAS ID
315425
Contact name
Sally Collins
Contact email
Sponsor organisation
Oxford University Hospitals NHS Foundation Trust
Duration of Study in the UK
0 years, 6 months, 0 days
Research summary
Summary of Research
The frequency of caesarean hysterectomies is increasing worldwide as a result of increasing rates of placenta accreta spectrum (PAS) linked to previous caesarean deliveries. Given the technical difficulties associated with these surgeries and the rates of complications such as lower urinary tract injury and significant blood loss, our team developed a systematic stepwise procedure for performing radical caesarean hysterectomies known as the Soleymani-Alazzam-Collins (SAC) technique. Using techniques adapted from radical gynaecologic oncology surgery this surgical approach has been shown to improve surgical outcomes without increasing theatre time, as well as resulting in more transverse scars, which many women prefer for aesthetic reasons. However, while the short-term surgical outcomes are improved with this novel technique, it is not known what the rates of long-term complications associated with this technique are.We are proposing to undertake a questionnaire study to assess the long-term complications associated with radical caesarean hysterectomy using the SAC technique. 24 women who had a planned caesarean hysterectomy, including 8 using the SAC technique, whose cases were analysed as part of the original analysis of the SAC technique will be contacted to see if they are willing to participate in follow-up and those that consent will be contacted via telephone to complete the questionnaire. The incidence of long-term complications including nerve damage, complications associated with the scar from the surgery, and alterations to bladder function. Complications associated with the incision used, with surgical access of the abdominal and pelvic blood vessels, and with mobilisation of the bladder will be assessed. Given that this is a novel surgical approach, it is important to identify long-term complications to better assess the safety of this approach and to help treat or prevent such outcomes in future.
Summary of Results
A questionnaire study to assess long term morbidity following the use of the Soleymani- Alazzam-Collins (SAC) Technique for the management of placenta accreta spectrum (PAS)This was a follow-up questionnaire-based study which sought to recruit women who had previously had a caesarean hysterectomy for placenta accreta spectrum, PAS. This is a very rare but potentially life-threatening pregnancy condition. A novel surgical approach was developed in Oxford in 2016 called the SAC technique. This was adapted from radical gynaecologic oncology surgery and had already been shown to improve surgical outcomes without increasing theatre time, as well as leaving transverse scars, which many women prefer for aesthetic reasons. However, while the short-term surgical outcomes are improved with this novel technique, it was not known what the rates of long-term complications associated with this technique were. This study sought to explore the long-term safety and acceptability of the technique.
The response rate of 63% was a little lower than we had hoped for but is completely understandable as we may have not had current contact details and people have busy lives. The data obtained from the completed questionnaires however has proved invaluable. We have been able to demonstrate that there is no long-term harm from tying off some specific pelvic blood vessels (the internal iliac arteries). This is an extremely important finding as doing this can be life-saving in PAS, yet some doctors will not do it as they believe it will inevitably lead to severe complications. The new technique uses a transverse incision which again many doctors will not employ for PAS surgery. Our data has demonstrated that should be offered to patients with severe PAS, due to its low complication rate, improved cosmetic appearance and patient satisfaction. However, women must be counselled that they may experience some, usually temporary, changes in skin sensation with this incision. Two papers are in preparation detailing the results.
We are very grateful to all of the women who took time to respond to our correspondence, as well as those who completed the questionnaire, they have made a real difference to the care of women with PAS in the future.
REC name
South East Scotland REC 01
REC reference
22/SS/0105
Date of REC Opinion
9 Nov 2022
REC opinion
Favourable Opinion