Using Tranexamic Acid In Laparoscopic Hysterectomy

Yıl 2014, Cilt: 11 Sayı: 1, 9 - 12, 01.01.2014

Ali Yavuzcan , Mete Çağlar Yusuf Üstün Serdar Dilbaz Atilla Özkara Selahattin Kumru

Öz

Objective: The aim of this study was to evaluate the effect of using systemic tranexamic acid TA preoperatively on operation time, difference in hemoglobin Hb levels measured before and after surgery delta Hb and duration of hospitalization in laparoscopic hysterectomy LH .Institution: Düzce University School of Medicine, Department of Obstetrics and Gynecology.Materials and Methods: The patients undergo LH with cystoscopy CYS with or without adnexectomy were included in this study. All the operations carried out by the same surgeon.Results: The patients receiving TA and patients not receiving TA were compared in terms of age and uterine weight. There was no statistically significant difference between two groups in terms of age and uterine weight p = 0.714 and p = 0.955 respectively . However, the average number of parity was to be significantly lower in the patients receiving TA p = 0.006 . There was not any statistically significant difference between the patients who received TA and who did not recieve in terms of operative time p =0.962 , delta Hb p = 0.870 and duration of hospitalization p = 0.759 .Conclusion: Our study did not demonstrate a positive effect of tranexamic acid after systemic administration on perioperative outcomes of LH . The effectiveness of TA in conventional open surgical procedures to reduce blood loss has been proven but further investigations to clarify the effectivity of TA on minimally invasive surgical approaches are needed.

Anahtar Kelimeler

laparoscopic hysterectomy, perioperative outcomes, tranexamic acid

Laparaskopik Histerektomi’de Traneksamik Asit Kullanımı

Öz

Amaç: Bu çalışmanın amacı preoperatif dönemde traneksamik asit TA uygulanmasının laparaskopik histerektomide LH operasyon süresi , preoperatif-postoperatif dönem arasındaki hemoglobin Hb değişimi delta Hb ve hospitalizasyon süresi üzerine etkisini değerlendirmektir.Çalışmanın Yapıldığı Yer: Düzce Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı.Materyal-Metod: Adneksektomi dahil yada hariç olmak üzere LH ile birlikte tanısal sistoskopi CYS işlemi yapılan hastalar çalışmaya dahil edilmiştir. Operasyonların hepsi aynı cerrah tarafından gerçekleştirilmiştir.Bulgular: TA kullanılan hastalar ile kullanılmayan hastalar arasında hasta yaşı ve uterin ağırlık açısından istatistiksel olarak anlamlı farklılık saptanmamıştır p=0,714 ve p=0,955 sırasıyla . Ancak ortalama parite sayısı TA uygulanan grupta istatistiksel olarak anlamlı olacak şekilde düşük tespit edilmiştir p=0,006 . Operasyonda TA uygulanan hastalar ile uygulanmayan hastalar arasında arasında operasyon süresi p=0,962 , delta Hb p=0,870 ve hospitalizasyon süresi p=0,759 açısından istatistiksel olarak anlamlı farklılık saptanmamıştır.Sonuç: Çalışmamızda TA uygulanmasının LH’de operasyon sonuçları üzerine olumlu etkisi gösterilememiştir. Konvansiyonel olarak yapılan açık cerrahi işlemlerde kan kaybını azalttığı ispatlanmış olan TA’nın minimal invaziv yöntemlerle yapılan operasyonlardaki etkinliğinin net olarak ortaya konabilmesi için geniş kapsamlı yeni araştırmalara gerek duyulmaktadır.

Anahtar Kelimeler

laparaskopik histerektomi, operasyon sonuçları, traneksamik asit

Kaynakça

• 1. Wilcox LS, Koonin LM, Pokras R, Strauss LT, XiaZ,Peterson HB.Hysterectomy in the United States,1988–1990. Obstet Gynecol 1994;83:549–5.
• 2. Roman H, Zanati J, Friederich L, Resch B, Lena E, Marpeau L. Laparoscopic hysterectomy of large uteri with uterine artery coagulation at its origin. JSLS 2008 r;12:25-9.
• 3. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: Practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy. J Minim Invasive Gynecol 2012 ;19:407-11
• 4. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, vanVoorst S, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane Database of Systematic Reviews 2009;3: CD003677.
• 5. Kluivers KB, Opmeer BC, Geomini PM, Bongers MY, Vierhout ME, Bremer GL, Mol BW. Women’s preference for laparoscopic or abdominal hysterectomy. Gynecol Surg 2009;6:223–8.
• 6. O’Hanlan KA, Dibble SL, Garnier AC, Reuland ML. Total laparoscopic hysterectomy: technique and complications of 830 cases. JSLS 2007; 11:45-53.
• 7. Twijnstra AR, Blikkendaal MD, vanZwet EW, van Kesteren PJ, de Kroon CD, Jansen FW. Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstet Gynecol 2012;119:700-8
• 8. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, Kauko M, Heikkinen AM, Sjöberg J. Morbidity of 10.110 hysterectomies by type of approach. Hum Reprod 2001;16:1473– 8.
• 9. Leminen H, Hurskainen R. Tranexamic acid for the treatment of heavy menstrual bleeding: efficacy and safety. Int J Womens Health 2012;4:413-21.
• 10. Ducloy-Bouthors AS, Jude B, Duhamel A, Broisin F, Huissoud C, Keita-Meyer H, Mandelbrot L, Tillouche N, et al. High-dose tranexamic acid reduces blood loss in postpartum haemorrhage. Crit Care. 2011;15:R117.
• 11. Sentürk MB, Cakmak Y, Yildiz G, Yildiz P. Tranexamic acid for cesarean section: a double-blind, placebo-controlled, randomized clinical trial. Arch Gynecol Obstet 2013;287:641-5.
• 12. Ergun B, Bastu E, Ozsurmeli M, Celik C.Tranexamic Acid: a potential adjunct to resectoscopic endometrial ablation.Int Surg 2012 ;97:310-4.
• 13. Jørgensen H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Effect of peri- and post operative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy. Br J Anaesth 2001;87:577-83.
• 14. Fiaccavento A, Landi S, Barbieri F, Zaccoletti R, Tricolore C, Ceccaroni M, Pomini P, Bruni F, et al.Total laparoscopic hysterectomy in cases of very large uteri: a retrospective comparative study.J Minim Invasive Gynecol 2007 ;14:559-63.
• 15. Craik JD, EiShafie SA, Kidd AG, Twyman RS.Can local administration of tranexamic acid during total knee arthro plastyreduce blood loss and transfusion requirements in the absence of surgical drains? Eur J Orthop SurgTraumatol. 2014;24:379-84.
• 16. Laffey JG, Boylan JF, Cheng DC. The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist. Anesthesiology 2002;97:215–2.
• 17. Robertshaw HJ. An anti-inflammatory role for tranexamic acid in cardiac surgery? Crit Care 2008;12:105.
• 18. Xu J, Gao W, Ju Y.Tranexamic acid for the prevention of postpartum hemorrhage after cesarean section: a double-blind randomization trial. Arch Gynecol Obstet 2013;287:463-8.
• 19. Ker K, Prieto-Merino D, Roberts I.Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss.Br J Surg. 2013;100:1271-9.