Jule ERİÇ HORASANLI, Gülnur EREN, Mehmet Sinan İYİSOY

Benign Over Tümörlerinde Laparoskopi ve Laparotomi Sonuçlarının Karşılaştırılması

Amaç: Bu çalışmada amacımız, klinik ve acil servise over kisti nedeniyle başvuran ve laparoskopi veya laparotomi uygulanan hastaların ameliyat özellikleri ve ameliyat sonuçları karşılaştırılarak hastanemizde elde edilen verileri sunmaktır. Gereç ve Yöntem: Bu retrospektif çalışmada over kistleri nedeniyle sistektomi, ooferektomi ve histerektomi salpingooferektomi yapılan hastalar laparoskopi ve laparotomi olmak üzere iki grupta karşılaştırıldı. Benign over kisti tanısı ile 2015-2020 yılları arasında opere edilen 443 hasta retrospektif olarak değerlendirildi. Hasta dosyalarındaki veriler yaş, kist boyutu, ameliyat sonrası hemoglobin ve ameliyat sonrası beyaz küre sayısı, ameliyat süresi, hastanede kalış ve insizyonel enfeksiyon açısından analiz edildi. Bulgular: Laparotomi ile cerrahi geçirenlerde, laparoskopi ile karşılaştırıldığında insizyonel enfeksiyon riski RR= 4.5 (1.74-11.67) kat artmış olarak görüldü. Hastane yatış süreleri tüm operasyon tiplerinde (ooferektomi, kistektomi ve histerekromi salpingooferektomi) laparoskopi yapılan hastalarda daha düşük olarak bulundu. Histerektomi salpingooferektomi olan hastalarda kist boyutları, laparotomi grubunda anlamlı olarak büyüktü. Operasyon süreleri karşılaştırıldığında, ooferektomi ve kistektomi yapılanlarda anlamlı bir fark bulunmazken, histerektomi salpingooferektomi yapılanlarda laparoskopi grubunda anlamlı olarak uzun bulundu. Kan transfüzyonu açısından tüm operasyon türleri kıyaslandığında laparoskopi grubunda anlamlı düşük olarak izlendi. Sonuç: Laparoskopik tedavi uygulanan hastaların daha az hastanede kalış süresi, kesi yeri enfeksiyonu, kan transfüzyonu gerekliliği, ameliyat süresi yaşadıklarını bulduk. Hastaların ortalama hastanede yatış süreleri ve komplikasyonlar açısından benign ovaryan kist cerrahisinde laparoskopik cerrahi yöntemler kistektomi, ooferektomi ve laparoskopik histerektomi hızlı ve effektif güvenle önerilebilir.

Anahtar Kelimeler:

Over Kisti, Laparoskopi, Laporotomi

Comparison of Laparoscopy and Laparotomy Results for Benign Ovarian Tumors

Abstract Objectives: To present the data generated at our hospital by comparing the operative characteristics and surgical results of patients who applied to the clinic and emergency room due to ovarian cyst and underwent laparoscopy or laparotomy. Materials and Methods: In this retrospective study, patients who underwent cystectomy, oophorectomy, and hysterectomy salpingo-oophorectomy due to ovarian cysts were compared in two groups, comprising laparoscopy and laparotomy. Evaluated retrospectively in this study were 443 patients operated on due to benign ovarian cyst diagnosis. Data in the patient files were analyzed in terms of age, cyst size, postoperative hemoglobin, postoperative white blood cell count, operating time, hospital stay, and surgical site infection. Results: Postoperative surgical site infection was significantly higher in the laparotomy group. The risk of surgical site infection was RR= 4. 5 (1.74–11.67) times higher in those who underwent laparotomy when compared to laparoscopy. The duration of hospital stay was lower in the laparoscopy group for all operation types (oophorectomy, cystectomy, and hysterectomy salpingo-oophorectomy). The cyst sizes of the patients who underwent hysterectomy salpingo-oophorectomy were significantly more significant in the laparotomy group. The duration of hospital stay in the patients who underwent hysterectomy salpingo-oophorectomy was significantly longer when compared to the laparoscopy group, while no significant difference was found in the oophorectomy and cystectomy patients. The need for blood transfusion was significantly lower in the laparoscopy group for all operation types. Conclusions: It was concluded that the duration of hospital stay, surgical site infection, need for blood transfusion, and operating time was less in patients who underwent laparoscopy. Laparoscopic surgery methods can be safely recommended for rapid and effective treatment of benign ovarian cysts with cystectomy, oophorectomy, and laparoscopic hysterectomy about hospital stay and complications.

Keywords:

Ovarian Cyst, Laparoscopy, Laparotomy,

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1. D. A. Grimes, L. B. Jones, L. M. Lopez, and K. F. Schulz, "Oral contraceptives for functional ovarian cysts," Cochrane Database of Systematic Reviews, 2011.
2. L. Hongqian, W. Xiangao, L. Donghao, L. G. S. Zhihong, and S. Gang, "Ovarian masses in children and adolescents in China: analysis of 203 cases," J Ovarian Res, vol. 6, p. 47, 2013.
3. W. Goh, J. Bohrer, and I. Zalud, "Management of the adnexal mass in pregnancy," Current Opinion in Obstetrics and Gynecology, vol. 26, pp. 49-53, 2014.
4. Z. Khanum and A. Rehman, "The prevalence & age distribution of ovarian cysts," Annals of King Edward Medical University, vol. 11, 2005.
5. N. Yesildaglar and P. Koninckx, "Adhesion formation in intubated rabbits increases with high insufflation pressure during endoscopic surgery," Human reproduction, vol. 15, pp. 687-691, 2000.
6. M. Feuerstein, T. Mussack, S. M. Heining, and N. Navab, "Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection," IEEE Transactions on Medical Imaging, vol. 27, pp. 355-369, 2008.
7. D. Tsolakidis, G. Pados, D. Vavilis, D. Athanatos, T. Tsalikis, A. Giannakou, et al., "The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study," Fertility and sterility, vol. 94, pp. 71-77, 2010.
8. A. Kumar and M. Pearl, "Mini-laparotomy versus laparoscopy for gynecologic conditions," Journal of minimally invasive gynecology, vol. 21, pp. 109-114, 2014. 9. L. R. Medeiros, D. D. Rosa, M. C. Bozzetti, J. M. Fachel, S. Furness, R. Garry, et al., "Laparoscopy versus laparotomy for benign ovarian tumour," Cochrane Database of Systematic Reviews, 2009.
10. S. Carlson, S. Batra, M. Billow, S. A. El-Nashar, and G. Chapman, "Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease," Journal of Minimally Invasive Gynecology, vol. 28, pp. 1060-1065, 2021.
11. D. Savary, M. Canis, and B. Rabishong, "Kystectomie ovarienne intrapéritonéale par voie coelioscopique," Journal de chirurgie (Paris. 1908), vol. 139, pp. 278-281, 2002.
12.] F. Pulcinelli, M. Schimberni, R. Marci, F. Bellati, and D. Caserta, "Laparoscopic versus laparotomic surgery for adnexal masses: role in elderly," World Journal of Surgical Oncology, vol. 14, pp. 1-5, 2016.
13. L. Chen, J. Ding, and K. Hua, "Comparative analysis of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy," Journal of Obstetrics and Gynaecology Research, vol. 40, pp. 763-769, 2014.
14. A. O. Awonuga, G. M. Saed, and M. P. Diamond, "Laparoscopy in Gynecologic Surgery:: Adhesion Development, Prevention, and Use of Adjunctive Therapies," Clinical obstetrics and gynecology, vol. 52, pp. 412-422, 2009.
15. D. E. Pittaway, P. Takacs, and P. Bauguess, "Laparoscopic adnexectomy: a comparison with laparotomy," American journal of obstetrics and gynecology, vol. 171, pp. 385-391, 1994.
16. B. G. Bateman, L. A. Kolp, and S. Mills, "Endoscopic versus laparotomy management of endometriomas," Fertility and sterility, vol. 62, pp. 690-695, 1994.
17. K. Gengeç, H. UYANIKOĞLU, A. İNCEBIYIK, S. Sibel, and M. ERDAL, "Kliniğimizde Yapılan Laparoskopik ve Laparotomik Histerektomilerin Karşılaştırılması," Harran Üniversitesi Tıp Fakültesi Dergisi, vol. 14, pp. 104-110, 2017.
18.] E. Lehmann-Willenbrock, H. Riedel, H. Mecke, and K. Semm, "Pelviscopy/laparoscopy and its complications in Germany, 1949-1988," The Journal of reproductive med., vol. 37, pp. 671-677, 1992.