Abdominal ve Laparoskopik Myomektomilerin Postoperatif Komplikasyonlar ve Fertilite Açısından Değerlendirilmesi

Year 2015, Volume: 16 Issue: 1, 37 - 44, 08.05.2015

Ayşegül Özel Seda Ateş Osman Şevket Zeynep Kayaoğlu Hasan Fehmi Yazıcıoğlu

Abstract

Amaç: Bu çalışmanın amacı myoma uteri nedeniyle uygulanan abdominal veya laparoskopik myomektomi yönteminin postoperatif komplikasyon ve ameliyat sonrası fertilite üzerine etkisinin karşılaştırılmasıdır.Gereç ve Yöntem: 2003-2007 yılları arasında Süleymaniye Kadın Hastalıkları ve Doğum Hastanesi’nde myomektomi yapılmış toplam 221 hastanın dosyası rektospektif olarak incelendi. Hastalar uygulanan cerrahi yönteme göre 2 gruba ayrıldı. 136 hastaya abdominal myomektomi, 85 hastaya laparoskopik myomektomi uygulanmış olup gruplar birbiriyle karşılaştırıldı.Bulgular: Gruplar arasında yaş, sigara içimi, geçirilmiş batın operasyonu ve geçirilmiş pelvik enfeksiyon öyküsü, postoperatif kan transfüzyon ihtiyacı ve ileus görülme bakımından anlamlı farklılık yoktu (p>0.05). Ortalama parite sayısı, laparoskopik myomektomi grubunda anlamlı olarak fazla idi (p =0.018). Abdominal myomektomi grubunda çıkarılan myom sayısının 4’ten fazla olması (p<0.01) ve myom büyüklüğünün 6 cm’den büyük olması (p<0.001) laparoskopik myomektomi grubuna göre anlamlı olarak fazla saptandı. Abdominal myomektomi grubunda operasyon süresi ve ortalama hastanede kalış süresi, laparoskopik myomektomi grubuna göre fazla (p <0.001), postoperatif hemotokrit değerleri laparoskopik myomektomi gruba göre düşük olarak saptandı (p<0.017). Laparoskopik myomektomi olgularında postoperatif toplam gebe kalma oranı ve

Keywords

Laparoskopik myomektomi, abdominal myomektomi, komplikasyon, fertilite

Abdominal ve Laparoskopik Myomektomilerin Postoperatif Komplikasyonlar ve Fertilite Açısından Değerlendirilmesi

Abstract

Objective: The aim of this study is to compare the postoperative complications of laparoscopic and abdominal myomectomy procedures for the myoma of uterus and their effects on postoperative fertility.Material and Methods: In this study, we retrospectively evaluated 221 cases who were performed myomectomy operation at Suleymaniye Obstetrics and Gynecology Hospital between 2003-2007. All cases were divided into two groups with respect to the surgical procedure performed. 136 patients were in the abdominal myomectomy (AM) group, 85 patients were in the laparoscopic myomectomy group and the groups were compared. Results: There is no significant difference in age, smoking, history of abdominal surgery, pelvic infection, postoperative need for transfusion, and ileus between the groups. The mean number of parity was higher in the laparoscopic myomectomy group. In abdominal myomectomy group, number of cases in which more than 4 myomas were removed (p<0.01) and number of cases in which myoma was greater than 6 cm in diameter (p<0.001) were higher than laparoscopic myomectomy group. The operation time and duration of hospital stay was longer (p <0.001), while postoperative hemotocrit levels were lower in abdominal myomectomy group when compared with laparoscopic myomectomy group (p<0.017). Postoperative cumulative pregnancy rate and pregnancy by assisted reproductive technology is higher in laparoscopic myomectomy group than abdominal myomectomy group ( p<0,001).Conclusion: There was no difference between the groups in complications during and after the operations, while laparoscopy was more advantageous than abdominal surgery with shorter time of surgery and hospital stay, less bleeding during the procedure and higher rates of pregnancy postoperatively

Keywords

Laparoscopic myomectomy, abdominal myomectomy, complication, fertility

References

• Wallach EE, Vlahos NF. Uterine myomas: an overwiew of development, clinical features, and management. Obstet Gynecol 2004;104(2):393- 406.
• Jacoby VL, Fujimoto VY, Giudice LC, Kuppermann M, Washington AE. Racial and ethnic disparities in benign gynecologic conditions and associated surgeries. Am J Obstet Gynecol 2010;202(6):514- 521.
• Islam MS, Protic O, Giannubilo SR, et al. Uterine leiomyoma: available medical treatments and new possible therapeutic options. J Clin Endocrinol Metab 2013;98(3):921-34.
• Tal R, Segars JH. The role of angiogenic factors in fibroidpathogenesis: potential implications for future therapy. Hum Reprod Update 2014;20(2):194-216.
• Jin C, Hu Y, Chen XC, et al. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2009;145(1):14-21.
• Cheng MH, Wang PH. Uterine myoma: a condition amenable to medical therapy? Expert Opin Emerg Drugs 2008;13(1):119-33.
• Semm K. New methods of pelviscopy (gynecologic laparoscopy) for myomectomy, ovariectomy, tubectomy 1979;11(2):85-93. adnectomy. Endoscopy
• Payne TN, Pitter MC. Robotic-assisted surgery for the community gynecologist: can it be adopted? Clin Obstet Gynecol 2011;54(3):391-411.
• Lefebvre G, Vilos G, Allaire C, et al. Clinical Practice Gynaecology Committee, Society for Obstetricians and Gynaecologists of Canada. The management of uterine leiomyomas. J Obstet Gynaecol Can 2003;25(5):396-418.
• Darai E, Deval B, Darles C, et al. Myomectomy: laparoscopy or laparotomy. Contracept Fertil Sex 1996;24(10):751-6.
• Advincula AP, Xu X, Goudeau S 4th, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myomectomy: a comparison of short- term surgical outcomes and immediate costs. J Minim Invasive Gynecol 2007;14(6):698-705.
• Sizzi O, Rossetti A, Malzoni M, et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 2007;14(4):453-62.
• Fanfani F, Fagotti A, Bifulco G, et al. A prospective study of laparoscopy versus minilaparotomy in the treatment of uterine myomas. J Minim Invasive Gynecol 2005;12(6):470-4.
• Kim MS, Uhm YK, Kim JY, Jee BC, Kim YB. Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach. Obstet Gynecol Sci 2013;56(6):375-81.
• Nezhat F, Seidman DS, Nezhat C, Nezhat CH. Laparoscopic myomectomy today. Why,when and for whom? Hum Reprod 1996;11(5):933-4.
• Parker WH. Laparoscopic myomectomy and abdominal myomectomy. Clin Obstet Gynecol 2006;49(4):789-97.
• Seinera P, Farina C, Todros T. Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients. Hum Reprod 2000;15(9):1993-6.
• Paul PG, Koshy AK, Thomas T. Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure. Hum Reprod 2006;21(12):3278-81.
• Marchionni M, Fambrini M, Zambelli V, Scarselli G, Susini T. Reproductive performance before and after abdominal myomectomy: a retrospective analysis. Fertil Steril 2004;82(1):154-9.
• Dessolle L, Soriano D, Poncelet C, et al. Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility. Fertil Steril 2001;76(2):370-4.
• Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril 1992;58(1):1-15.
• Smith DC, Uhlir JK. Myomectomy as a reproductive procedure. Am J Obstet Gynecol 1990;162(6):1476-9.
• Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 2000;15(12):2663-8.
• Malzoni M, Tinelli R, Cosentino F, et al. Laparoscopy versus minilaparotomy in women with symptomatic uterine myomas: short-term and fertility results. Fertil Steril 2010;93(7):2368- 73.