Şükrü YILDIZ, Cihan KAYA, İsmail ALAY, Murat EKİN, Levent YAŞAR

Laparoskopik endometrioma kistektomi cerrahilerinde elektrokoagülasyon veya sütür tekniği ile sağlanan hemostazın rekürrens ve gebelik sağlama oranına etkisi

Amaç: Bu çalışmanın amacı, tek veya bilateral endometriomalarda laparoskopik kistektomi sonrası elektrokoagülasyon veya sütür tekniği uygulaması ile sağlanan hemostazın, endometrioma rekürrensi ve spontan gebelik oranlarına etkisinin değerlendirilmesidir.Gereç ve Yöntem: 18-42 yaş aralığında herhangi bir yardımcı üreme tedavisi desteği almayan 46 primer infertil hasta retrospektif olarak analiz edildi. Laparoskopik kistektomi operasyonu, sıyırma tekniği ile uygulandı. Over doku kanaması sütür (n=23) veya bipolar elektrokoagülasyon (n=22) ile kontrol edildi. Kist rekürrensi postoperatif olarak ultrason eşliğinde değerlendirildi. Spontan gebelik adet gecikmesi sonrası kan Beta- insan koryonik gonadotropin (B-hCG) seviyesi bakılarak saptandı.Bulgular: Ortalama yaş 31.62±6.55 olarak saptandı. Gruplar arasında istatistiksel olarak yaş, vücut kitle indeksi (BMI), preopertaif endometrioma büyüklüğü, pre/postoperatif hemoglobin (hb) ve hemotokrit (Hct) değeri ile anlamlı bir fark saptanmadı. Sütür grubunda rekürrens oranı fazla çıksa da istatistiksel olarak anlamlı bulunmadı. Spontan gebelik oranı her iki grupta benzer saptandı. Çalışma gruplarında endometrioma lateralitesinde istatistiksel olarak bir fark saptanmadı.Sonuç: Bu çalışma, Endometrioma cerrahisi sonrası uygulanan elektrokoagülasyon veya sütür tekniğinin endometrioma rekürrensi ve spontan gebelik oranlarına farklı etkisinin olmadığını göstermiştir.

Anahtar Kelimeler:

endometriozis, rekürrens, hemostaz, kistektomi

The effect of hemostasis by electrocoagulation versus suture on endometrioma recurrence and pregnancy rates after laparoscopic cystectomy in endometriomas

Purpose: The aim of this study was to assess the effect of hemostasis by electrocoagulation versus suture on endometrioma recurrence and pregnancy rates after laparoscopic cystectomy in uni/bilateral endometriomas. Materials and Methods: Forty-six primary infertile patients wishing to conceive without any assisted reproductive treatments, between 18 and 42 years, with uni/bilateral endometriomas were retrospectively analyzed. Laparoscopic cystectomies were performed by the stripping method. Ovarian hemostasis was obtained either by suturing (n = 23) or by bipolar electrocoagulation (n = 22). Cyst recurrence was evaluated by postoperative ultrasound scan. Pregnancy was confirmed by serum Beta-human choronic gonadotropin (B-hCG) levels if the patient presented with menstrual delay. Results: The mean of age of the patients was 31.62±6.55 years old. There was no significant difference between study groups regarding age, body mass index (BMI), preoperative endometrioma size, or pre/post-operative hemoglobin/hematocrite (Hb/Htc) levels. The recurrence rate was higher in the electrocoagulation group than the suturing group; however, the difference was not statistically significant. The spontaneous pregnancy rates were also similar between study groups. There was no significant difference between study groups considering unilaterality or bilaterality of endometriomas. Conclusion: Our preliminary data show that an operation on ovarian endometriomas-either electrocoagulation or suturing-may not affect endometrioma recurrence or spontaneous pregnancy rate.

Keywords:

endometriosis, recurrence, haemostasis, cystectomy,

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