Comparison of laparoscopic and abdominal hysterectomy for benign disease

Abstract

Objective: The aim of this study was to compare the intraoperative and short term postoperative complications between the abdominal and laparoscopic hysterectomies for women with benign disease.

Material and Method: In this retrospective cohort study, we analyzed the files of the 253 patients who underwent total abdominal or laparoscopic hysterectomy for benign conditions in our clinic between January 2011 and December 2013. The operating time, blood loss, the major complication rate and the duration of hospital stay were compared between the abdominal and the laparoscopic hysterectomy groups respectively.

Results: Among the total of the 253 patients, hysterectomy was performed abdominally for 151 (60%) patients and laparoscopically for the 102 (40%) patients. The operating time was found to be significantly longer for the laparoscopic approach (p = 0.001). No statistically significant difference was found between the groups for the major complication rate (p = 0.560).  Postoperative decline for hemoglobin levels in the abdominal hysterectomy group was higher than in the laparoscopic group (p = 0.031). The duration of hospital stay was found to be shorter in the laparoscopic group (p = 0.004). The conversion rate to open surgery was 12%.

Conclusion: Laparoscopic hysterectomy has more advantages than abdominal hysterectomy when compared for time needed for postoperative recovery, abdominal discomfort after surgery and cosmetically results. The major complication rates were similar for the two approaches. When vaginal approach is not appropriate for the patient, laparoscopic hysterectomy should be considered as the first option for the surgery.

Keywords

• blood loss
• endoscopy
• gynecologic surgery
• hysterectomy
• laparoscopy

Benign endikasyonlarda laparoskopik ve abdominal histerektomi

Öz

Amaç: Bu çalışmanın amacı benign endikasyonlarla yapılan histerektomilerde laparoskopik yaklaşım ile abdominal yaklaşımın intraoperatif ve kısa dönem postoperatif komplikasyonlarını karşılaştırmak.

Gereç ve Yöntem: Bu retrospektif kohort çalışmasında Ocak 2011-Aralık 2013 tarihleri arasında benign nedenlerle total abdominal ve laparoskopik histerektomi yapılan 253 hastanın orijinal dosyaları ve ameliyat raporları analiz edildi. İki ayrı histerektomi yaklaşımı operasyon süresi, kan kaybı, majör komplikasyonlar ve hastanede yatış süresi açısından karşılaştırıldı.

Bulgular: Toplam 253 hastanın 151 tanesine (%60) abdominal, 102 (%40) tanesine laparoskopik histerektomi yapılmıştır. Operasyon süresi laparoskopik histerektomi grubunda anlamlı olarak daha uzun saptandı (p = 0,001). Majör komplikasyonlar açısından laparoskopik histerektomi ile abdominal histerektomi arasında fark saptanmadı (p = 0,560). Postoperatif hemoglobin düşüşü TAH grubunda daha fazlaydı (p = 0,031). Hastanede yatış süresi laparoskopik histerektomi grubunda anlamlı olarak daha kısaydı (p = 0,004). Laparoskopik histerektomi de laparotomiye dönme oranı %12 olarak saptandı.

Sonuç: Laparoskopik histerektomi abdominal histerektomiye oranla kısa iyileşme periyodu, daha az postoperatif rahatsızlık, daha iyi kozmetik sonuçlar gibi birçok avantaja sahiptir. Her iki yaklaşımdaki majör komplikasyon oranı benzerdir. Vajinal histerektominin uygun olmadığı hastalarda laparoskopik yaklaşım abdominal yaklaşıma tercih edilmelidir. 

Anahtar Kelimeler

• kan kaybı
• endoskopi
• jinekolojik cerrahi
• histerektomi
• laparoskopi

Kaynakça

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