Gülümser Ece AKSAKAL, Simge PESEN, Elif GUNDOGDU, Taner USTA

Laparoskopik ve Laparotomik Yaklaşimla Yapilan Histerektomi Vakalarinda Vezikovajinal ve Üreterovajinal Fistül Gelişme Oranlarinin Karşilaştirilmasi

Bu çalışmada laparoskopik ve abdominal histerektomiler ürogenital fistül oranlarının karşılaştırılması ve etiyolojisinde yer alan faktörlerin değerlendirilmesi amaçlanmıştır. Üriner sistem pelvik operasyonlar esnasında risk altındadır ve bu hasarlar ürogenital fistül oluşumuna sebebiyet verebilir. En sık sorumlu tutulan operasyon benign jinekolojik sebeplerle yapılan histerektomilerdir ve vezikovajinal fistüllerin yaklaşık %75’inden sorumlu tutulmaktadır. Yakın geçmişe kadar laparoskopik histerektomi abdominal histerektomilere kıyasla daha yüksek oranda üriner sistem hasarı ile ilişkilendirilmiştir. Bu çalışmada 01.01.2011 - 01.01.2016 tarihleri arasında Bağcılar Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum kliniğinde laparoskopik ve abdominal histerektomi yapılan 1357 hastanın medikal kayıtları geriye dönük analiz edilerek üreterovajinal veya vezikovajinal fistül tanısı konulan hastalar değerlendirildi. Çalışma sonucunda abdominal histerektomi sonrası ürogenital fistül, 7 hastada (%0,7), laparoskopik histerektomi sonrası ise 3 hastada (%0,8) bulunmuştur. Herhangi bir cerrahi yaklaşımın bir diğerine ürogenital fistül oluşum riskini azaltma açısından üstünlüğü veya dezavantajı saptanmamıştır. Histerektomide seçilen cerrahi yaklaşım ile üriner sistem hasarlarının karşılaştırıldığı pek çok çalışma olsa da en güvenli yaklaşımın hangisi olduğu konusunda tartışmalar devam etmektedir. Komplikasyonlar en deneyimli cerrahın ellerinde bile kaçınılmaz olsa da yeterli sütür tekniğinin geliştirilmesi ve pelvik anatomiye hakimiyet ile minimalize edilebilir.

Anahtar Kelimeler:

Histerektomi, Komplikasyon, Laparoskopik histerektomi, Ürogenital fistül

Comparison of Vesicovaginal and Ureterovaginal Fistula Ratios in Laparoscopic and Laparotomic Hysterectomy

The urinary tract is at risk of injury during pelvic operations, such injuries may lead to urogenital fistula. Historically, regarding the approach for hysterectomy, the risk of ureteral injury appeared to be the greatest during laparoscopic hysterectomy. The most frequently accused pelvic operation is hysterectomies performed for benign gynecological reasons and is responsible for approximately 75% of vesicovaginal fistulas. The main reason for this experience in laparoscopy has been growing tremendously, recently. This study aims to evaluate the incidence, clinical presentation and etiological factors of urogenital fistula in laparoscopic and abdominal hysterectomy cases. The medical records of 1357 cases of laparoscopic and abdominal hysterectomy performed at Bagcilar Training and Research Hospital, Department of Obstetrics and Gynaecology between 1 January 2011 to 1 January 2016 was analysed retrospectively. All patients with diagnosis of ureterovaginal or vesicovaginal fistula were further evaluated. Seven cases (0.7%) of ürogenital fistula were secondary to abdominal hysterectomy and three cases (0.8%) of urogenital fistula were secondary to laparoscopic hysterectomy. We found no evidence that any choice of hysterectomy approach is superior to or inferior to the other techniques regarding formation of urogenital fistula. Although there are several studies for comparison of urinary tract injuries during abdominal and laparoscopic hysterectomy, debate continues regarding the safest approach for hysterectomy. While complications are inevitable, even in the hands of a skilled surgeon, they can be minimized by a sufficiently developed suturing technique and an excellent knowledge of pelvic anatomy.

Keywords:

Complication, Hysterectomy, Laparoscopic Hysterectomy, Urogenital fistula,

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