ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORİJİNAL ARAŞTIRMALAR

Total Abdominal Histerektomi ve Total Laparoskopik Histerektomi Yapılan Hastaların Klinik Sonuçlarının Karşılaştırılması
Comparison of Clinical Results in Patients With Total Abdominal Hysterectomy and Total Laparoscopic Hysterectomy
Received Date : 16 May 2021
Accepted Date : 12 Oct 2021
Available Online : 01 Dec 2021
Doi: 10.24074/tjrms.2021-84488 - Makale Dili: EN
TJRMS. 2021;5(3):73-8
ÖZET
Amaç: Bu çalışmanın amacı hastanemizde yapılan total laparoskopik histerektomi (TLH) ve total abdominal histerektomi (TAH) ameliyatlarının klinik sonuçlarını karşılaştırmaktır. Gereç ve Yöntemler: Necmettin Erbakan Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'na Ocak 2015-Ocak 2021 tarihleri arasında başvuran ve total histerektomi uygulanan 353 hastanın klinik kayıtları retrospektif olarak incelendi. 152 hastaya TLH (Grup1) ve 202 hastaya TAH (Grup2) uygulandı. Hastaların ortalama yaşı, vücut kitle indeksi (BKİ), uterus hacmi, operasyon süresi, kan kaybı miktarı, komplikasyon oranları ve postoperatif hastanede kalış süresi iki grup arasında karşılaştırıldı. Bulgular: Bu iki grup arasında ortalama yaş, ortalama vücut kitle indeksi (VKİ), ameliyat öncesi ve sonrası hemoglobin (hb) değerleri açısından istatistiksel olarak anlamlı fark yoktu. Her iki grupta da cerrahi için en yaygın endikasyon myoma uteri idi. Ortalama ameliyat süresi grup 1’de daha uzundu ve bu istatistiksel olarak anlamlıydı (122,3±37,0 dakika-96,9±28,4, p <0,001). Grup 1 hastalarda ortalama hastanede kalış süresi daha kısaydı ve bu istatistiksel olarak anlamlıydı (24.0 (24.0-48.0) h-72.0 (72-72) saat, p <0.001). TAH grubundaki hastalar daha yüksek bir ortalama örnek ağırlığına sahipti. Sonuç: Laparoskopik histerektomi daha uzun bir operasyon süresine sahiptir. Ancak daha küçük bir kesi hattı daha az ağrı, daha az kan kaybı ve daha hızlı iyileşme sağlar. Bu nedenle seçilmiş hastalar için avantajların daha fazla olduğu söylenebilir.
ABSTRACT
Objective: The aim of our study is to compare the clinical results of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) surgeries performed in our hospital. Material and Methods: The clinical records of 353 patients who applied to Necmettin Erbakan University Faculty of Medicine, Department of Obstetrics and Gynecology between January 2015 and January 2021 and underwent total hysterectomy were retrospectively reviewed. TLH (Group1) was applied to 152 patients and TAH (Group2) was applied to 202 patients. The mean age of the patients, body mass index (BMI), uterine volume, operation time, amount of blood loss, complication rates and postoperative hospital stay were compared between the two groups. Results: There was no statistically significant difference between these two groups in terms of mean age, mean body mass index (BMI), pre- and postoperative hemoglobin (hb) values. The most common indication for surgery in both groups was myoma uteri. The mean operative time was longer in group 1 and this was statistically significant (122.3±37.0 minutes-96.9±28.4, p <0.001). The mean hospital stay was shorter in group 1 patients and this was statistically significant (24.0 (24.0-48.0) h-72.0 (72-72) hours, p <0.001). Patients in the TAH group had a higher mean sample weight. Conclusion: Laparoscopic hysterectomy has a longer operation time. However, a smaller incision line provides less pain, less blood loss and faster recovery. Therefore, it can be said that the advantages are more for selected patients.
SITE.TEXT.RESOURCES
  1. Reich H. New techniques in advanced laparoscopic surgery. Baillieres Clin Obsstet Gynaecol. 1989;3:655-81. [Crossref] 
  2. Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015. [Crossref]  [PubMed]  [PMC] 
  3. Wiser A, Holcroft CA, Tulandi T, Abenhaim HA. Abdominal versus laparoscopic hysterectomies for benign diseases: evaluation of morbidity and mortality among 465,798 cases. Gynecol Surg. 2013;10:117-22. [Crossref] 
  4. Schindlbeck C, Klauser K, Dian D, Janni W, Friese K. Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet. 2008;277:331-7. [Crossref]  [PubMed] 
  5. Protopapas A, Jardon K, Bourdel N, Botchorishvili R, Rabischong B, Mage G, et al. Total laparoscopic radical hysterectomy in the treatment of early cervical cancer. Int J Gynecol Cancer. 2009;19:712-22. [Crossref]  [PubMed] 
  6. Istre O, Snejbjerg D. Complication Rate of Laparoscopic Hysterectomies in Denmark, 2011- 2016. JSLS. 2018;22:e2017.00078. [Crossref]  [PubMed]  [PMC] 
  7. Janda M, Gebski V, Brand A, Hogg R, Jobling TW, Land R, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol. 2010;11:772-80. [Crossref] 
  8. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2009;144(1):3-7. [Crossref]  [PubMed] 
  9. Barnett JC, Havrilesky LJ, Bondurant AE, Fleming ND, Lee PS, Secord AA, et al. Adverse events associated with laparoscopy versus laparotomy in the treatment of endometrial cancer. Am J Obstet Gynecol. 2011; 205(143): e141-6. [Crossref]  [PubMed] 
  10. Ditto A, Martinelli F, Bogani G, Gasparri ML, Di Donato V, Zanaboni F, et al. Implementation of laparoscopic approach for type B radical hysterect omy: a comparison with open surgical operations. Eur J Surg Oncol. 2015; 41:34-9. [Crossref]  [PubMed] 
  11. Barber EL, Neubauer NL, Gossett DR. Risk of venous thromboembolism in abdominal versus minimally invasive hysterectomy for benign conditions. Am J Obstet Gynecol. 2015;212(609): e601-7. [Crossref]  [PubMed] 
  12. Jackson TD, Wannares JJ, Lancaster RT, Rattner DW, Hutter MM. Does speed matter? The impact of operative time on outcome in laparoscopic surgery. Surg Endosc. 2011;25: 2288-95. [Crossref]  [PubMed]  [PMC] 
  13. Berek DD. Berek & Novak's Gynecology. Philadelphia: Lippincott Williams & Wilkins; 2012. p.1254-5.
  14. Mattingly RF, Thompson JD. Leiomyomata uteri and abdominal hysterectomy for benign disease. In: JD Thompson., editor. In Te Linde's Operative Gynecology, 6th ed. Edited by RF Mattingly. Philadelphia: JB Lipincott; 1985. pp. 230-42.
  15. Härkki-Sirén P, Sjöberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand. 2000;79:866-71. [Crossref]  [PubMed] 
  16. Çelik C, Abali R, Tasdemir N, Aksu E, Çalışkan H, Akkuş D. Comparison of total laparoscopic hysterectomy and abdominal hysterectomy; Clinical Results. JCAM 2014. 2014
  17. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet. 2003;83:37-43. [Crossref] 
  18. Komatsu H,Taniguchi F,Nagata H,Nakaso T,Nagaya Y,Tsukihara SSet al. . Retrospective evaluation of the crucial factor in total laparosco pic hysterectomy by using video review. Laparosc Surg. 2019;3(23):10.21037/ls.2019.05. 05 [Crossref] 
  19. Phipps JP, John M, Nayak S. Comparison of laparoscopic assisted vaginal hysterectomy and bilateral salpingo-ophorectomy with conventional abdominal hysterectomy and bilateral salpingo-ophorectomy. Br J Obstet Gynaecol. 1993;110:698-700. [Crossref]  [PubMed] 
  20. Raju KS, Auld BJ. A randomized prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy. Br J Obstet Gynaecol. 1994;101(12):1068-71. [Crossref]  [PubMed] 
  21. Howard FM, Sanchez R. A comparison of laparoscopic assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg. 1993;9(2):83-90. [Crossref]  [PubMed] 
  22. Nezhat F, Nezhat C, Gordons S, Wilkins F. Laparoscopic versus abdominal hysterectomy. J Reprod Med. 1992;37(3):247-50.
  23. Phipps A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod. 1999; 14(12):2996-9. [Crossref]  [PubMed] 
  24. Ellstrom M, Bengtsson A, Tylman M, Haeger M, Olsson JH, Hahlin M. Evaluation of tissue trauma after laparoscopic and abdominal hysterectomy: measurements of neutrophil activation and release of interleukin-6, cortisol, and C-reactive protein. J Am Coll Surg. 1996; 182(5):423-30.
  25. Labib M, Palfrey S, Paniagua E, Callender R. The postoperative inflammatory response to injury following laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy. Ann Clin Biochem. 1997;34(5):543-5. [Crossref]  [PubMed] 
  26. Olsson JH, Ellstro¨m M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103(4):345-50. [Crossref]  [PubMed] 
  27. Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Ass Gynecol Laparosc. 2002; 9(3):333-8. [Crossref] 
  28. Wattiez A, Soriano D, Cohen SB, et al. Total laparoscopic learning curve hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc. 2002;9(3):339-45. [Crossref] 
  29. Makinen J, Johansson J, Tomas C, Tomás E, Heinonen P K, Laatikainen T, et al. Morbidity of 10110 hysterectomy type of approach. Hum Reprod. 2001;16(7):1473-8. [Crossref]  [PubMed] 
  30. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hys-terectomy: systematic review and meta-analysis of randomized controlled trials. BMJ. 2005; 330(7506):1478. [Crossref]  [PubMed]  [PMC]