Sandwich excision in patients with placenta percreta involving maternal bladder

J.-P. Feng, D.-Z. Fan, D.-X. Lin, H.-S. Zhang, J.-M. Rao, Z.-P. Liu

Department of Obstetrics, Foshan Institute of Fetal Medicine, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan, Guangdong, China. liuzphlk81@outlook.com

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• Obstetrics

OBJECTIVE: Our aim is to describe and assess a Sandwich Excision (placenta-uterine-bladder excision together) surgical technique for women with clinically confirmed placenta percreta involving the maternal bladder.

PATIENTS AND METHODS: A retrospective cohort study was performed on all patients with clinically confirmed placenta percreta involving the maternal bladder who underwent Sandwich Excision at our large academic institution from January 1, 2014, to June 30, 2019.

RESULTS: Twenty-three patients were included. Four patients underwent hysterectomy, and one patient underwent subhysterectomy. The mean duration of surgery was 228.04 ± 85.59 minutes (range, 90.00-503.00 minutes). The mean estimated blood loss was 5,269.57 ± 2,745.81 mL (range, 1,000.00-12,500.00 mL). No thromboembolic events occurred, and there were no maternal or neonatal deaths among the subjects in this study.

CONCLUSIONS: Sandwich excision is associated with a low rate of hysterectomy in women with placenta percreta involving the maternal bladder. The procedure is a relatively safe technique and can be performed safely by experienced obstetricians who are familiar with the uterus-bladder space. Meanwhile, the success rates and complications of the Sandwich Excision in these patients also need to be evaluated in prospective studies.

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