Benign uterus patolojileri için yapılan histerektomi metodlarının değerlendirilmesi

Abstract

Comparison of hysterectomy methods performed due to benign uterine pathologies

Abstract

ABSTRACT Aim : The aim of this study is to compare the intraoperative and postoperative complications of laparoscopic and abdominal approaches in hysterectomies performed for benign indications in our clinic. Materials and Methods: This is a retrospective, cross-sectional study. Between 01.09.2021 and 01.02.2024, the medical records and surgical reports of 209 patients who underwent total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) for benign uterine pathologies at the Department of Obstetrics and Gynecology, Namık Kemal University Faculty of Medicine in Tekirdağ were analyzed. The two different hysterectomy approaches were compared in terms of operation time, blood loss, major complications, and length of hospital stay. Results: The average age of the 209 patients included in the study was 48.34 ± 7.9 years. The most common indication for hysterectomy was abnormal uterine bleeding (AUB) in 47.8% of cases, followed by myomas in 17.7%. A total of 134 patients (64.6%) underwent TAH, and 74 patients (35.4%) underwent TLH. In 16 patients (8.1%), the procedure was converted from laparoscopic to open surgery. No significant differences were found between the groups in terms of age, parity, and gravidity (p > 0.05). There were no statistically significant differences in preoperative and postoperative hemoglobin (Hb) levels between the TAH and TLH groups (p > 0.05). No significant differences were found in operation times and hospital stay duration (p > 0.05). The average uterine size and average myoma size were significantly larger in the TAH group (p < 0.05). Perioperative complication rates were similar between the groups (p > 0.05). The need for blood transfusions and analgesics was significantly higher in the abdominal hysterectomy group (p < 0.05). Conclusion: Laparoscopic hysterectomy offers several advantages over abdominal hysterectomy, including shorter recovery time, less postoperative discomfort, and better cosmetic outcomes. Major complication rates are similar for both approaches. In cases where vaginal hysterectomy is not suitable, laparoscopic approach should be preferred over abdominal approach.

Keywords

• laparoscopy
• hysterectomy
• uterine pathology

References

1. 1. Mehta A, Xu T, Hutfless S, Makary MA, Sinno AK, Tanner EJ 3rd, et al. Patient, surgeon, and hospital disparities with benign hysterectomy approach and perioperative complications. Am J Obstet Gynecol. 2017;216(5):497.
2. 2. Margulies SL, Vargas MV, Denny K, Sparks AD, Marfori CQ, Moawad G, et al. Comparing benign laparoscopic and abdominal hysterectomy outcomes by time. Surg Endosc. 2020;34(2):758-769.
3. 3. Vree FE, Cohen SL, Chavan N, Einarsson JI. The impact of surgeon volume on perioperative outcomes in hysterectomy. JSLS 2014;18(2):174-81.
4. 4. Demirayak G, Kılık T, Çetinkaya FN, Bulut B, Akbaş M, Kılınc A, et al. Laparaskopik Histerektomi Deneyimlerimiz. Okmeydanı Tıp Dergi-si 2016;32(4):198-203.
5. 5. Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Kluiners KB. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev. 2015(8):CD003677.
6. 6. O’Hanlan KA, Emeney PL, Frank MI, Milanfar LC, StenMS, Uthman KF. Total Laparoscopic Hysterectomy: Making It Safe and Successful for Obese Patients. JSLS 2021;25(2):e2020.00087.
7. 7. Istre O, Snejbjerg D. Complication Rate of Laparoscopic Hysterectomies in Den-mark,2011-2016. JSLS 22(1):e2017.00078.
8. 8. Buhur A, Erdem D. Total laparoskopik histerek-tomi ile total abdominal histerektomi olguları-nın karşılaştırılması. Ege Tıp Dergisi 2022;61(4):541-548 .

9. 9. Madhvani K, Fernandez-Felix BM, Zamora J, Carpenter T, Khan KS. Personalizing the risk of conversion from laparoscopic to open hysterectomy in benign conditions: Development and external validation of risk prediction models. BJOG 2022;129(7):1141-1150.
10. 10. Beyan E, İnan AH, Emirdar V, Budak A, Tutar SO, Kanmaz AG. Comparison of the Effects of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy on Sexual Function and Quality of Life. Biomed Res Int. 2020;8:8247207.
11. 11. Vree FE, Cohen SL, Chavan N, Einarsson JI. The impact of surgeon volume on perioperative outcomes in hysterectomy. JSLS 2014İ18(2):174-81.
12. 12. Balikoğlu M, Bayraktar B, Filiz D, Beyan E, Inan AH, Özeren M. The effect of experience on the outcomes of total laparoscopic hysterectomy surgery:1295 cases. Ginekol Pol. 2022;93(9):681-651.
13. 13. Akgör U, Kuru O, Güneş AC, Karataş E, Temiz BE, Erzeneoğlu BE, et al. Impact of clinicopathological variables on laparoscopic hysterectomy complications, a tertiary center experience. Ginekol Pol. 2022;93(2):105-111. 14. Louie M, Strassle PD, Moulder JK, Dizon AM, Schiff LD, Carey ET. Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy. Am J Obstet Gyne-col.2018;219(5):480.e1-480.e8
14. 15. Uccella S, Morosi C, Marconi N, Arrigo A, Giso-ne B, Casarin J, et al. Laparoscopic Versus Open Hysterectomy for Benign Disease in Uteri Weighing>1 kg: A Retrospective Analysis on Patients. J Minim Invasive Gynecol. 2018;25(1):62-69.
15. 16. Norrbom C, Osler M, Krabbe-Sorensen M, Rasmussen SC, carlsen SE, Nilas L, et al. Risk of Bowel Obstruction After Hysterectomy for Benign Indication According to Surgical Met-hod in Denmark, 1984-2013. J Minim Invasive Gynecol. 2024;31(10):855-869.e6