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

Yıl 2019, Cilt: 10 Sayı: 2, 217 - 222, 12.06.2019

Erkan Şimşek Pınar Kadiroğulları , Kerem Doğa Seçkin , Onur Karaaslan Hüseyin Kıyak Gökhan Yıldırım

https://doi.org/10.18663/tjcl.491042

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

• 1. ACOG Committee Opinion No. 444. Choosing the route of hysterectomy for benign disease. Obstet Gynecol 2009; 114: 1156–58.
• 2. Stang A, Merrill RM, Kuss O. Prevalence-corrected hys- terectomy rates by age and indication in Germany 2005– 2006. Arch Gynecol Obstet 2012; 286: 1193–200.
• 3. Jacobson GF, Shaber RE, Armstrong MA, Hung YY. Hysterectomy rates for benign indications. Obstet Gynecol 2006; 107: 1278–83.
• 4. Turner LC, Shepherd JP, Wang L, Bunker CH, Lowder JL. Hysterectomy surgery trends: a more accurate depiction of the last decade? Am J Obstet Gynecol 2013; 208: 1– 7.
• 5. Abdelmonem AM. Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2010; 151: 190–92.
• 6. Siddiqui NY, Fulton RG, Kuchibhatla M, Wu JM. Sexual function after vaginal versus nonvaginal prolapse surgery. Female Pelvic Med Reconstr Surg 2012; 18: 239–42.
• 7. Helstrom L, Lundberg PO, Sorbom D, Backstrom T. Sexuality after hysterectomy: A factor analysis of women’s sexual lives before and after subtotal hysterectomy. Obstet Gynecol 1993; 81: 357–62.
• 8. Komisaruk BR, Frangos E, Whipple B. Hysterectomy im- proves sexual response? Addressing a crucial omission in the literature. J Minim Invasive Gynecol 2011; 18: 288–95.
• 9. Wilke I, Merker A, Schneider A. Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Surg Endosc 2001; 15: 1144-46.
• 10. Chen B, Ren DP, Li JX, Li CD. Comparison of vaginal and abdominal hysterectomy: A prospective non-randomized trial. Pak J Med Sci 2014; 30 : 875–79.
• 11. De La Cruz JF, Myers EM, Geller EJ. Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: a comparison of postoperative vaginal length and sexual function. J Minim Invasive Gynecol 2014; 21: 1010–14.
• 12. Tan JS, Lukacz ES, Menefee SA, Luber KM, Albo ME, Nager CW. Determinants of vaginal length. Am J Obstet Gynecol 2006; 195: 1846–50.
• 13. Ercan O, Özer A, Köstü B, Bakacak M, Kıran G, Avcı F. Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. International Journal of Gynecology and Obstetrics 2016; 132: 39-41
• 14. Ostrzenski A. Laparoscopic total abdominal hysterectomy by suturing technique, with no transvaginal surgical approach: a review of 276 cases. Int J Gynaecol Obstet 1996; 55: 247–257.
• 15. Turner LC, Lavelle ES, Shepherd JP. Comparison of complications and prolapse recurrence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse. Int Urogynecol J 2016; 27: 797–803.
• 16. Worldwide AAMIG. AAGL practice report: Practice Guidelines on the Prevention of Apical Prolapse at the Time of Benign Hysterectomy. J Minim Invasive Gynecol 2014; 21: 715–722.
• 17. Buhling KJ, Schmidt S, Robinson JN, Klapp C, Siebert G, Dudenhausen JW. Rate of dyspareunia after delivery in primiparae according to mode of delivery. Eur J Obstet Gynecol Reprod Biol 2006; 124: 42–46.
• 18. Batish A, Sathiyathasan S, Jeyanthan K. Vault Heamatoma after vaginal hysterectomy. Nepal J Obstet Gyneacol 2014; 9: 70-72.
• 19. Puri M, Singh A, Patvkar M, Tyagi S, Sharma P, Singhania SS. Ultrasound evaluation of vault hematoma after vaginal hysterectomy and its correlation with postoperative morbidity. J Pharm Biomed Sci 2012; 25: 212-17.
• 20. Kdous M, Braham M, Ferchiou M, Zhioua F. Hysterectomy in women with benign uterine disease. a prospective randomized comparison of three minimally invasive procedures. Donnish J Med Med Sci 2015; 2: 96-102.
• 21. Chaudhry SM, Anwer S. Presentation and management of vaginal vault hematoma after hysterectomy. J Surg Pakistan 2016; 21: 35-38.
• 22. Shreejana H, Ju WH, Wang XR, Li H. Evaluation of post hysterectomy vaginal cuff related complications and their management after different modes of hysterectomy. Intel J Repod Contracept Obstet Gynecol 2015; 4: 447-52.