CLINICAL EVALUATION OF TOTAL LAPAROSCOPIC HYSTERECTOMY CASES WITH GRADE 3 - 4 ADHESIONS: ESKİSEHİR EXPERIENCE

Year 2021, Volume: 22 Issue: 5, 360 - 365, 04.08.2021

Ceren Yıldız Eren , Özlem Özgür Gürsoy , Hulusi Göktuğ Gürer , Ramazan Bayırlı

https://doi.org/10.18229/kocatepetip.760580

Abstract

OBJECTIVE: This study aims to evalute the clinical results of 35 cases that underwent total laparoscopic hysterectomy (TLH) and had grade 3 - 4 adhesions.
MATERIAL AND METHODS: This is a retrospective study of 35 TLH cases with grade 3 - 4 adhesions out of 155 TLH operations performed for benign indications between January 2017 and July 2020. Data related with the demographic characteristics, hysterectomy indications, uterine weight, intraoperative and postoperative complications, duration of the operation, length of hospital stay and amount of blood loss were noted. Complications were classified as major, minor, and total complications according to the literature.
RESULTS: The mean age, parity and body mass index of the patients were 49,6±6,4 (37-63) years; 1,8±0,9 (0-4) and 27,6 ± 5,8 (18 - 39) kg/m2 respectively. The mean adhesion score defined during operation was grade 3,3 ±0,4 (3 - 4). The most common reason of adhesions was the history of abdominal surgery which was observed in %51,4 of cases (18/35). In the remaining cases, endometriosis and pelvic inflammatory disease were defined as the reasons of adhesions. The mean uterine weight, operative time, length of hospital stay and amount of blood loss were 264,7±201,9 g (80-1075 g), 108,4±24,9 min (65 - 175 min), 3,2 ±1,4 days (2-9 days) and 285,7±144,4 ml (100-800 ml) respectively. Total, major and minor complication rates were %17,1 (6/35), %8,5 (3/35) and 8.5% (3/35) respectively.
CONCLUSIONS: Although TLH is a well- designed surgical procedure for the management of benign gynecological conditions, patients with high grade intraperitoneal adhesions have still higher complication rates. These patients should be informed adequately and TLH should be planned in consideration of possible complications.

Keywords

Total laparoscopic hysterectomy, Adhesion, Complication

EVRE 3 - 4 ADEZYONU OLAN OLGULARDA LAPAROSKOPİK HİSTEREKTOMİ OPERASYONLARININ KLİNİK DEĞERLENDİRMESİ: ESKİŞEHİR DENEYİMİ

Abstract

AMAÇ: Total laparoskopik histerektomi (TLH) yapılan ve evre 3 - 4 adezyonu olan 35 hastanın retrospektif değerlendirilmesi amaçlanmıştır.
GEREÇ VE YÖNTEM: Ocak 2017 ve Haziran 2020 arasında benign endikasyonlar nedeniyle TLH uygulanan 155 olgudan evre 3 - 4 adezyonu olan 35 olgu çalışmaya dahil edildi. Demografik özellikleri, histerektomi endikasyonları, uterus ağırlıkları, intraoperatif ve postoperatif komplikasyonları, operasyon süresi, hastanede kalış süresi ve kan kaybı retrospektif olarak değerlendirildi. Komplikasyonlar literatüre uygun olarak majör komplikasyonlar, minör komplikasyonlar ve total komplikasyonlar olarak sınıflandırıldı.
BULGULAR: Hastaların yaş ortalaması 49,6±6,4 (37 - 63), parite ortalaması 1,8±0,9 (0 - 4) ve vücut kitle indeksi ortalaması 27,6 ± 5,8 (18-39) kg/m2 idi. Operasyon sırasında yapılan değerlendirme skorlamasına göre hastaların adezyon evresi ortalama 3,3 ±0,4 (3 - 4) olarak bulundu. Vakaların %51,4'ünde (18/35), adezyon oluşumunun nedeni olarak geçirilmiş intraperitoneal cerrahi gösterildi. Diğer vakalarda endometriozis ve pelvik enflamatuar hastalık, adezyon nedenleri olarak düşünüldü. Postoperatif değerlendirmede uterus ağırlığı ortalaması 264,7±201,9 g (80-1075 g), operasyon süresi ortalaması 108,4±24,9 dk. (65-175 dk.), hastanede ortalama yatış süresi 3,2 ±1,4 gün (2-9 gün) ve ortalama total kan kaybı 285,7±144,4 ml (100-800 ml) olarak bulundu. Majör komplikasyon oranı %8,5 (3/35), minör komplikasyon oranı %8,5 (3/35) ve toplam komplikasyon oranı %17,1 (6/35) olarak saptandı.
SONUÇ: TLH, benign jinekolojik vakalarda iyi bir cerrahi tercih olsa da, ileri evre intra-peritoneal adezyonu olan olgularda komplikasyon oranlarının yüksek olduğu akılda tutulmalıdır. Bu hastalar yeterince bilgilendirilmeli ve olası komplikasyonlar gözönünde bulundurularak TLH planlanmalıdır.

Keywords

total laparoskopik histerektomi, adezyon, komplikasyonlar

References

• 1. Orhan A, Ozerkan K, Kasapoğlu I et al. Laparoscopic hysterectomy trends in challenging cases ( 1995-2018 ). J Gynecol Obstet Hum Reprod. 2019; 48(10): 791-8.
• 2. Tarik A, Fehmi C. Complications of Gynaecological laparoscopy - a retrospective analysis of 3572 cases from a single institute. J Obstet Gynaecol. 2004;24(7):813-6.
• 3. Nezhat C, Childers J, Nezhat F, Nezhat CH, Seidman DS. Major Retroperitoneal Vascular Injury During Laparoscopic Surgery. Hum Reprod 1997; 12(3): 480-3.
• 4. Royal College of Obstetricians and Gynaecologists (RCOG). Classification of laparoscopic procedures per level of difficulty. Report of the RCOG working party on training in gynecological endoscopic surgery. London: RCOG, 2001.
• 5. Mazuji MK, Calambaheti K, Pover B. Prevention of Adhesions with polyvinylpyrrolidone. Preliminary Report. Arch Surg.1964; 89: 1011–15.
• 6. Johanna W M Aarts , Theodoor E Nieboer, Neil Johnson, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Datebase Syst Rev. 2015(8): CD003677.
• 7. Committee on Gynecologic Practice. Committee Opinion No 701: Choosing The Route of Hysterectomy for Bening Disease. Obstet Gynecol. 2017;129(6):155-9.
• 8. Wattiez A, Sariano D Cohen SB, et al. The learning curve of total laparoscopic hysterectomy; comparative analysis of 1647 cases J Am Assoc Gynecol Laparosc. 2002; 9(3): 339-45.
• 9. Whiteman MK, Hillis SD Jamiesan DJ, et al. Inpatient hysterectomy surveillance in the united states , 2000-2004. AM J Obstet Gynecol. 2008; 198(1): 1-7.
• 10. Garry R, Fountain J, Masun S 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(7432): 129.
• 11. Sridhar M, Susmitha C. Comparison of open abdominal hysterectomy and total laparoscopic hysterectomy: a study in a teaching hospital. Int Surg J. 2016;3:296-300.
• 12. Cheung VY, Rosenthal DM Morton M, Kadanka H. Total Laparoscopic Hysterectomy: A Five-Year Experience. J Obstet Gynaecol Can. 2007; 29(4): 337-43.
• 13. Bonilla DJ, Mains L, Rice J, Crawford B. Total Laparoscopic Hysterectomy: Our 5-year Experience (1998-2002). Ochsner J. 2010;10(1): 8-12.
• 14. Nagata H, Kamatso H, Nagaya Y, et al. Comparison of Total Laparoscopic Hysterectomy With Abdominal Total Hysterectomy in Patients With Benign Disease: A Retrospective Cohort Study. Yonago Acta Med. 2019; 62(4): 273-7.
• 15. O’Hanlan KA, Dibble SL, Garnier AC, Revland ML. Total Laparoscopic Hysterectomy: Technique and Complications of 830 Cases. JSLS. 2007; 11(1): 45-53.
• 16. Lovie M, Strassle PD, Moulder JK, Dizon AM Schiff- Ld, Carey ET. Uterine Weight and Complications After Abdominal, Laparoscopic, and Vaginal Hysterectomy. Am J Obstet Gynecol. 2018; 219(5): 480.e1-e8.
• 17. McDonnell RM, Hollingworth JL, Chivers P, Cohen PA, Salfinger SG. Advanced Training of Gynecologic Surgeons and Incidence of Intraoperative Complications after Total Laparoscopic Hysterectomy: A Retrospective Study of More Than 2000 Cases at a Single Institution. Journal of Minimally Invasive Gynecology. 2018; 25(5),810-15.
• 18. Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease : a single centre , single surgeon prospective study of complications canfirming previous retrospective study. BJOG. 2010; 117(6): 752-5.
• 19. Dallas KB, Rogo Gruptal ElliottCS. Urologic in jury and fistula after hysterectomy for benign indications. Obstet Gynecol. 2019; 134(2): 241-9.
• 20. Aydın C, Mercimek MD. Laparoscopic managemant of bladder injury during total laparoscopic hysterectomy. Int J Clin Pract. 2020; 74(6): e13507.
• 21. Bretschneider CE, Casas-Puig V, Sheyn D Hijaz A, Ferrardo CA. Delayed recognition of lower ürinary tract injuries following hysterectomy for benign indications: ANSQIP-based study. Am J Obstet Gynecol. 2019; 221(2): 132.e1-e13.
• 22. Lim S, Lee S, Choi J, Chon S, Lee K, Shin J. Safety of Total Laparoscopic Hysterectomy in Patients With Prior Cesarean Section. J Obstet Gynaecol Res. 2017; 43(1): 196-201.
• 23. Yinghua Xu , Qiming Wang, Furan Wang. Previous Cesarean Section and Risk of Urinary Tract Injury During Laparoscopic Hysterectomy: A Meta-Analysis. Int Urogynecol J. 2015; 26(9): 1269-75.
• 24. Baekelandt J, De Mulder PA, Le Roy I, et al. Postoperative Outcomes and Quality of Life Following Hysterectomy by Natural Orifice Transluminal Endoscopic Surgery (NOTES) Compared to Laparoscopy in Women with a Non-Prolapsed Uterus and Benign Gynaecological Disease: A Systematic Review and Meta-Analysis. Eur J Obstet Gynecol Reprod Biol. 2017; 208: 6-15.