LAPAROSKOPİK HİSTEREKTOMİ ÖNCESİ MEKANİK BARSAK HAZIRLIĞI YAPILMALI MIDIR? Should Mechanical Bowel Preparation Be Done Before Laparoscopic Hysterectomy?
Abstract
ÖZET
Giriş: Laparoskopik histerektomi jinekolojik operasyonlar içinde sık uygulanan cerrahi bir prosedürdür. Laparoskopik
histerektomi öncesi yapılan mekanik barsak hazırlığı açısından farklı görüşler bulunmaktadır. Biz bu
çalışmada, benign jinekolojik patolojiler nedeniyle yapılacak laparoskopik histerektomi öncesi mekanik barsak
hazırlığı yapılmasının gerekli olup olmadığını incelemeyi amaçladık.
Gereç ve Yöntem: Çalışmada, benign jinekolojik nedenlerle Haziran 2017 ve Haziran 2018 tarihleri arasında
laparoskopik histerektomi ameliyatı yapılan 63 hastanın verileri retrospektif olarak analiz edilmiştir. Hastaların
24’ünde barsak hazırlığı yapılmadığı 39’unda ise mekanik barsak hazırlığı yapıldığı tespit edilmiştir. Hastaların
yas¸, parite, vücut kitle indeksi, gec¸irilmis¸ cerrahi o¨yku¨su¨, histerektomi endikasyonları, operasyon su¨resi, uterus
ağırlığı, hastanede yatıs¸ su¨releri, intraoperatif ve postoperatif komplikasyonları karşılaştırılmıştır.
Bulgular: Hastaların demografik verileri incelendiğinde yaş, parite, vücut kitle indeksi ve geçirilmiş pelvik
cerrahi öykü arasında fark yoktur (p>0.05). Histerektomi endikasyonlarına bakıldığında myoma uteri, ilaca
dirençli menometroraji, adneksiyal kitle, servikal displazi ve kronik pelvik ağrı arasında istatistiksel anlamlı
fark izlenmemiştir. Operasyon süresi, barsak hazırlığı yapılan hastalarda barsak hazırlığı yapılmayan hastalara
göre istatistiksel anlamlı olarak daha kısa bulunmuştur (p<0.05). Perioperatif ve postoperatif komplikasyonlar
açısından bakıldığında fark bulunmamıştır (p>0.05).
Sonuç: Literatürde benign jinekolojik nedenlerle histerektomi yapılan hastalar için mekanik barsak hazırlığının
gerekip gerekmediği hakkında farklı görüşler mevcuttur. Bizim çalışmamızda mekanik barsak hazırlığı yapılmasının
perioperatif ve postoperatif komplikasyon oranını değiştirmediği fakat operasyon süresini anlamlı
derecede kısalttığı görülmüştür. Bundan dolayı uygun hastalara operasyon öncesi barsak hazırlığı yapılması
faydalı olabilir.
Anahtar kelimeler: Laparoskopik histerektomi; Mekanik barsak hazırlığı; Jinekolojik operasyon.
ABSTRACT
Aim: Laparoscopic hysterectomy is a common surgical procedure in gynecologic operations. There are different
opinions in terms of mechanical bowel preparation before laparoscopic hysterectomy. In this study, we
aimed to investigate whether mechanical bowel preparation is necessary before laparoscopic hysterectomy
due to benign gynecologic pathologies.
Materials and Methods: In this study, the data of 63 patients who underwent laparoscopic hysterectomy
between June 2017 and June 2018 for benign gynecological reasons were analyzed retrospectively. It was determined
that 24 patients had no bowel preparation and 39 patients had mechanical bowel preparation. Age,
parity, body mass index, previous surgical history, hysterectomy indications, operation time, uterine weight,
length of hospital stay, intraoperative and postoperative complications were compared.
Results: When demographic data of the patients were examined, there was no difference between age, parity,
body mass index and previous pelvic surgery history (p> 0.05). When hysterectomy indications were examined,
no statistically significant difference was observed between myoma uteri, drug-resistant menometrorrhagia,
adnexal mass, cervical dysplasia and chronic pelvic pain. Operative time was significantly shorter in
patients who had bowel preparation compared to patients without bowel preparation (p <0.05). There was no
difference between perioperative and postoperative complications (p> 0.05).
Conclusion: There are different opinions in the literature regarding the need for mechanical bowel preparation
for patients undergoing hysterectomy for benign gynecological reasons. In our study, mechanical bowel
preparation did not change the perioperative and postoperative complication rates, but it significantly reduced
the operation time. Therefore, preoperative bowel preparation may be useful for appropriate patients.
Key words: laparoscopic hysterectomy; mechanical bowel preparation; gynecological operation.
References
- 1. Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:1156-8. 2. Reich H, De Caprio J, Mc Klynn F. Laparoscopic hysterectımy. J Gynaecol Surg 1989;5:909-10. 3. Kluivers KB, Opmeer CB, Geomini PM, Bongers MY, Vierhout ME, Bremer GL, et al. Women’s preference for laparoscopic or abdominal hysterec- tomy. Gynecol Surg 2009:6;223-8. 4. Garry R, Fountain J, Mason S, Napp V, Brown J, Hawe J et al. The evaluate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004;328:129. 5. Siedhoff MT, Clark LH, Hobbs KA, Findley AD, Moulder JK, Garrett JM. Mechanical bowel preparation before laparoscopic hysterectomy. Am J Obstet Gynecol. 2014;123:562–7. 6. Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 2008;12:2037–44. 7. Muzii L, Bellati F, Zullo MA, Manci N, Angioli R, Panici PB. Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial. Fertil Steril. 2006;85:689–93. 8. Won H, Maley P, Salim S, Rao A, Campbell N, Abbott J. Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery. Am J Obstet Gynecol. 2013;121:538–46. 9. Russmann S, Lamerato L, Motsko SP, Pezzullo JC, Faber MD, Jones JK. Risk of further decline in renal function after the use of oral sodium phosphate or polyethylene glycol in patients with a preexisting glomerular filtration rate below 60 ml/min. Am J Gastroenterol 2008;103:2707-16. 10. Oliveira MA, Pereira TR, Gilbert A, Tulandi T, de Oliveira HC, De Wilde RL. Bowel complications in endometriosis surgery. Best Pract Res Clin Obstet Gynaecol. 2016;35:51-62. 11. Lijoi D, Ferrero S, Mistrangelo E, Casa ID, Crosa M, Remorgida V, et al. Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial. Arch Gynecol Obstet. 2009;280:713-8. 12. Koninckx PR, Timmermans B, Meuleman C, Penninckx F. Complications of CO2-laser endoscopic excision of deep endometriosis. Hum Reprod 1996;11:2263-8. 13. Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 2004;91:1125-30. 14. Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011;7:CD001544.
Abstract
References
- 1. Choosing the route of hysterectomy for benign disease. ACOG Committee Opinion No. 444. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009;114:1156-8. 2. Reich H, De Caprio J, Mc Klynn F. Laparoscopic hysterectımy. J Gynaecol Surg 1989;5:909-10. 3. Kluivers KB, Opmeer CB, Geomini PM, Bongers MY, Vierhout ME, Bremer GL, et al. Women’s preference for laparoscopic or abdominal hysterec- tomy. Gynecol Surg 2009:6;223-8. 4. Garry R, Fountain J, Mason S, Napp V, Brown J, Hawe J et al. The evaluate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004;328:129. 5. Siedhoff MT, Clark LH, Hobbs KA, Findley AD, Moulder JK, Garrett JM. Mechanical bowel preparation before laparoscopic hysterectomy. Am J Obstet Gynecol. 2014;123:562–7. 6. Pineda CE, Shelton AA, Hernandez-Boussard T, Morton JM, Welton ML. Mechanical bowel preparation in intestinal surgery: a meta-analysis and review of the literature. J Gastrointest Surg. 2008;12:2037–44. 7. Muzii L, Bellati F, Zullo MA, Manci N, Angioli R, Panici PB. Mechanical bowel preparation before gynecologic laparoscopy: a randomized, single-blind, controlled trial. Fertil Steril. 2006;85:689–93. 8. Won H, Maley P, Salim S, Rao A, Campbell N, Abbott J. Surgical and patient outcomes using mechanical bowel preparation before laparoscopic gynecologic surgery. Am J Obstet Gynecol. 2013;121:538–46. 9. Russmann S, Lamerato L, Motsko SP, Pezzullo JC, Faber MD, Jones JK. Risk of further decline in renal function after the use of oral sodium phosphate or polyethylene glycol in patients with a preexisting glomerular filtration rate below 60 ml/min. Am J Gastroenterol 2008;103:2707-16. 10. Oliveira MA, Pereira TR, Gilbert A, Tulandi T, de Oliveira HC, De Wilde RL. Bowel complications in endometriosis surgery. Best Pract Res Clin Obstet Gynaecol. 2016;35:51-62. 11. Lijoi D, Ferrero S, Mistrangelo E, Casa ID, Crosa M, Remorgida V, et al. Bowel preparation before laparoscopic gynaecological surgery in benign conditions using a 1-week low fibre diet: a surgeon blind, randomized and controlled trial. Arch Gynecol Obstet. 2009;280:713-8. 12. Koninckx PR, Timmermans B, Meuleman C, Penninckx F. Complications of CO2-laser endoscopic excision of deep endometriosis. Hum Reprod 1996;11:2263-8. 13. Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 2004;91:1125-30. 14. Güenaga KF, Matos D, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011;7:CD001544.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Case Report |
| Authors | |
| Publication Date | December 27, 2019 |
| Published in Issue | Year 2019 Volume: 9 Issue: 4 |