Laparoscopic Hysterectomy: One Center Experience Of 5 Years

Öz

Objective : To evaluate the laparoscopic hysterectomy cases performed in our hospital; regarding the patient characteristics, operation indications, surgical technique and postoperative outcomes and analyze the complications in order to reduce their occurrence.Material and Method : Laparoscopic hysterectomy operations performed in our clinic from December 2009 to January 2015 were analyzed retrospectively.Results : Ninety two patients underwent laparoscopic hysterectomy; 58 total laparoscopic hysterectomy and bilateral salphingo-ooferectomy TLH-BSO , 33 TLH, 4 laparoscopy assisted vaginal hysterectomy LAVH , 1 TLH-Burch was performed. Six operations were converted to laparotomy 6,5% failure rate . Mean age was 47.62 ±6.33 years 35-66 . Mean operating time was 139 ± 44 min 60-375 . Mean duration of hospital stay was 3.1 ± 2.0 days 1-13 .Hysterectomy indications were endometrial hyperplasia n=39, 42.4% , myoma uteri n=24, 26.1% , menometrorrhagia n=20, 21.7% , positive surgical margin in HSIL n=6, 6.5% , adnexal mass n=3, 3.3% .Post-operative complications were fever in 7 patients, vaginal cuff hematoma in 2 patients, vaginal cuff infection in 4 patientsand incision-site infection in one patient. Other complications were; bladder perforation, ureterovaginal fistula, trocar-site hernia, and pulmonary embolism.The patient who developed ureterovaginal fistula had a history of bladder operation and the patient with bladder perforation had a history of two cesarean sections.The trocar-site herniation was diagnosed by ultrasonography which is performed due to ileus symptoms of the patient on post-operative second dayConclusion: Laparoscopy has pervaded and brought a new vision to surgery with its advantages compared to open surgery; complications like fever, infection, trocar site hernia, pulmonary embolism, bladder perforation and ureterovaginal fistula may occur in total laparoscopic hysterectomy series. Careful selection of patients, adequate training and post-operative close follow up is essential to reduce the morbidities.

Anahtar Kelimeler

• Laparoscopic hysterectomy,post-operative complications

Laparoskopik Histerektomi: 5 Yıllık Tek Merkez Deneyimi

Öz

Amaç : Hastanemizde yapılan laparoskopik histerektomi vakalarının, hasta özelliklerini, operasyon endikasyonlarını, cerrahi tekniği ve postoperatif sonuçlarını değerlendirmek ve komplikasyonları analiz etmek.Gereç ve Yöntemler : Aralık 2009 ve Ocak 2015 tarihleri arasındaki laparoskopik histeroskopi operasyonları retrospektif olarak değerlendirildi.Bulgular : Doksan iki hastaya laparoskopik histerektomi yapıldı; 58 hasta total laparoskopik histerektomi ve bilateral salpingooferektomi TLH-BSO , 33 TLH, 4 laparoskopi asiste vajinal histerektomi LAVH , 1 TLH-Burch gerçekleştirildi. Altı operasyonda laparotomiye geçildi %6,5 başarısızlık oranı . Ortalama yaş 47.62 ±6.33 35-66 , ortalama operasyon süresi 139 ± 44 dakika 60-375 , ortalama hospitalizasyon süresi 3.1 ± 2.0 1-13 gün idi.Histerektomi endikasyonları; endometrial hiperplazi n=39, 42.4% , myoma uteri n=24, 26.1% , menometroraji n=20, 21.7% , HSIL sonrası pozitif cerrahi sınır n=6, 6.5% , adneksiyal kitle n=3, 3.3% idi.Post-operatif komplikasyonlar; 7 hastada ateş, 2 hastada vajinal kaf hematomu idi. Kaf enfeksiyonu, insizyon yeri enfeksiyonu, mesane perforasyonu, ureterovajinal fistül, trokar-yeri hernisi ve pulmoner emboli birer hastada görüldü. Üreterovajinal fistül gelişen hastada geçirilmiş mesane opreasyonu öyküsü, mesane perforasyonu gelişen hastada ise geçirilmiş 2 adet sezeryan öyküsü mevcuttu Trokar yeri hernisi saptanan hastada tanı, postoperatif ikinci günde gelişen ileus tablosu sonucu yapılan ultrasonografi ile kondu.Sonuç : Laparosokopi açık cerrahiyle karşılaştırıldığındaki avantajları ile laparoskopi yaygınlaşmış ve cerrahiye yeni bir vizyon getirmiştir. Total laparoskopik histerektomi serilerinde ateş, enfeksiyon, trokar yeri hernisi, pulmoner emboli, mesane perforasyonu ve üretrovajinaş fistül gibi komplikasyonlar görülebilir. Hastaların dikkatli seçimi, yeterli eğitim ve post-operatif yakın takip morbiditeyi azaltmada önemlidir.

Anahtar Kelimeler

• Laparoskopik histerektomi,post-operatif komplikasyonlar

Kaynakça

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