Comparison of postoperative vaginal length and cuff hematoma in patients undergoing hysterectomy by laparoscopy or laparotomy

Öz

Aim: We aimed to compare postoperative vaginal lengths and risk of occurrence of cuff hematoma after laparoscopic and laparotomic hysterectomy operations performed with benign indications according to the operation technique.

Material and Methods: Between January 2017 and January 2018, 267 patients who underwent total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) with benign indications were evaluated. Before the operation demographic characteristics of the patients, the results of probe curettage, smear results, previous operations and chronic diseases were recorded. After hysterectomy the patients were discharged following 1st and 2nd day controls. The presence of cuff hematoma was evaluated by transvaginal ultrasound on the 7th postoperative day and vaginal lengths were measured after hysterectomy by aid of hegar bougie.

Results: There was no significant difference between the two groups of 200 patients, including age, gravida, parity, history of operation, history of chronic disease, and demographic characteristics. Treatment-resistant menometrorrhagia was the most common indication in 44 patients (44%), whereas myoma uteri 96 (96%) were the most common indication in patients with TAH. After hysterectomy, vaginal length was calculated as 6.35 ± 0.81 cm in TLH group and 6.73 ± 0.92 cm in TAH group. The difference between the two groups was statistically significant (p = 0.002). When the presence of cuff hematoma was evaluated, 14 patients in the TLH group and 18 patients in the TAH group were found to have no significant difference between the groups.

Conclusion: It has been observed that the development of hematoma on the vaginal cuff in the postoperative period is not affected by the operation type of the patients performed hysterectomy. In addition, it is observed that the demographic characteristics of the patients in the preoperative period do not have a great effect on the type of operation. In patients performed TLH, the postoperative vaginal length is shorter than in patients with TAH. However, postoperative vaginal length measurement is a criterion that can be evaluated in the second plan. Primarly, surgical option should be determined by considering preoperative indications and its suitability for minimally invasive surgery.

Anahtar Kelimeler

• laparoscopy,laparotomy,cuff hematoma,vaginal length

Laparoskopi veya laparatomi ile histerektomi uygulanan hastaların postoperatı̇f vajı̇nal uzunluk ve kaf hematomu yönünden karşılaştırılması

Öz

Amaç: Benign endikasyonlar nedeniyle yapılan laparoskopik ve laparotomik histerektomi ameliyatları sonrası, postoperatif vajinal uzunluk değerlerinin ve kaf hematomu oluşma riskinin belirlenerek, operasyon tekniğine göre karşılaştırılması amaçlanmıştır.

Gereç ve Yöntemler: Ocak 2017 - Ocak 2018 tarihleri arasında beningn endikasyonlar ile total laparoskopik histerektomi (TLH) ve total abdominal histerektomi (TAH) yapılan 267 hasta değerlendirildi. Hastaların operasyon öncesi demografik özellikleri, probe küretaj sonuçları, smear sonuçları, geçirilmiş ameliyatları ve kronik hastalıklarıyla ilgili bilgileri kaydedildi. Hastalar histerektomi sonrası 1. ve 2. gün kontrolleri yapılarak taburcu edildiler. Postoperatif 7. gün kontrole çağrılarak transvajinal ultrason ile kaf hematomu varlığı değerlendirildi ve hastaların hegar bujisi yardımı ile histerektomi sonrası vajinal uzunlukları ölçüldü.

Bulgular: Çalışmada kalan 200 hastayı içeren iki grup arasında yaş, gravida, parite, geçirilmiş operasyon öyküsü, kronik hastalık hikayesi gibi demografik özellikler arasında anlamlı fark saptanmadı. TLH olan hastalarda tedaviye dirençli menometroraji 44 (%44) en sık saptanan operasyon endikasyonu iken, TAH olan hastalarda myoma uteri 96 (%96) en sık endikasyon olarak saptandı. Histerektomi sonrası vajinal uzunluk, TLH grubunda 6,35±0.81 cm, TAH grubunda 6.73±0.92 cm olarak hesaplanmış olup, iki grup arasındaki fark istatiksel olarak anlamlı izlenmiştir (p=0.002).Kaf hematomu varlığı değerlendirildiğinde, TLH grubunda 14 hasta, TAH grubunda 18 hastada saptanmış olup, gruplar arasında anlamlı fark izlenmemiştir.

Sonuç: Histerektomi olan hastalarda postoperatif dönemde vajen kafında hematom gelişiminin operasyon şeklinden etkilenmediği ve ayrıca preoperatif dönemdeki demografik hasta özelliklerinin operasyon şekline çok büyük etkide bulunmadığı gözlenmektedir. TLH yapılan hastalarda postoperatif vajinal uzunluk, TAH yapılan hastalara kıyasla daha kısa olarak izlenmektedir. Ancak, hastanın postoperative vajinal uzunluk ölçümü ikinci planda değerlendirilebilen bir kriter olup öncelikle preoperative endikasyonlar ve minimal invaziv cerrahiye uygunluğu gözetilerek cerrahi seçeneği belirlenmelidir.

Anahtar Kelimeler

• Laparoskopi,Laparotomi,Kaf Hematomu

Kaynakça

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