Five-year Total Laparoscopic Hysterectomy Experience in Second-Line Hospital

INTRODUCTION: We aimed to present our experience with total laparoscopic hysterectomy operations in second-line hospital METHODS: 250 cases who underwent total laparoscopic hysterectomy in the obstetrics and gynecology clinic between January 2012 and November 2017 were retrospectively evaluated in terms of age, parity, body mass index (BMI), preoperative and postoperative hemoglobin (Hb) and hematocrit (Htc) values, hysterectomy indications, the rate of switching from laparoscopy to laparotomy, blood transfusion requirement, operation time, complications, the length of hospital stay and uterine weight. In the morning of operation, venous blood was taken for measuring preoperative Hb and Htc values. RESULTS: The mean age of the patients was 48.01 ± 5.7. The mean operation time and the mean duration of hospitalization were 156.5 ± 49.4 minutes and 3.75 ± 1.04 days respectively. Mean uterine weight was 201.03 ± 107.2 grams. In one patient (0.4%), there was a transition from laparoscopy to laparotomy. Perioperative-postoperative blood transfusion was needed at three patients (%1.2). Intraoperative complications were sigmoid colon serosa injury in 1 patient (%0.4) and bladder perforation in 3 patients (%1.2) and a. full-thickness rectum injury in one patient (%0.4) has occurred. In postoperative period, vaginal cuff hematoma was and the vesicovaginal fistula was developed in 1 (%0.4) and 1 (%0.4) patient respectively. The postoperative fever and C-Reactive Protein (CRP) elevation were detected in four patients (1.6%). The overall complication rate was %5.6. DISCUSSION and CONCLUSION: Total laparoscopic hysterectomy is a minimally invasive procedure with less morbidity and mortality than experienced laparotomy, shorter postoperative follow-up, and better cosmetic results.

İkinci Basamak Hastanede Beş Yıllık Total Laparoskopik Histerektomi Deneyimiz

GİRİŞ ve AMAÇ: İkinci basamak hastanede yapılan total laparoskopik histerektomi operasyonları ile ilgili deneyimlerimizi sunmayı amaçladık YÖNTEM ve GEREÇLER: Ocak 2012- Kasım 2017 tarihleri arasında hastanemizde yapılmış olan 250 total laparoskopik histerektomi vakasının tıbbi kayıtlarını retrospektif olarak incelendi. Hastaların yaşı, paritesi, vücut kitle endeksi (BMI), histerektomi nedenleri, geçirilmiş abdominal cerrahi öyküsü, ameliyat öncesi ve sonrası ortalama hemoglobin (Hb) ve hemotokrit (Htc) değerleri arasındaki fark, operasyon sırasında ve sonrasında kan transfüzyonu ihtiyacı, operasyon süresi, hastanede yatış süresi, komplikasyonlar, laparatomiye geçiş sıklığı ve uterus ağırlığı değerlendirildi. BULGULAR: Hastaların ortalama yaşı 48.01±5,7 yıl olarak saptandı. Ortalama operasyon süresi ve ortalama hastanede yatış süresi sırasıyla 156.5±49,4 dakika ve 3.75±1,04 gün olarak hesaplandı. Laparaskopiden laparatomiye geçiş sadece bir hastada (%0.4) meydana geldi. Ortalama uterus ağırlığı 201.03±107.2 gr olarak saptandı. Üç hastaya (%1.2) intraoperatif kanama nedeniyle eritrosit süspansiyonu verildi. Cerrahi sırasında 1 (%0.4) hastada rektum seroza hasarı, 3 (%1,2) hastada mesane perforasyonu, 1 (%0.4) hastada rektum tam kat hasar meydana geldi. Postoperatif dönemde vajen kaf hematomu ve vezikovajinal fistül sırasıyla 1 (%0.4), 1 (%0.4) hastada gelişmiştir. Dört hastada (%1.6) postoperative ateş ve C-Reaktif Protein (CRP) yüksekliği tespit edildi. Toplam komplikasyon oranı %5.6 olarak saptandı TARTIŞMA ve SONUÇ: Total laparoskopik histerektomi deneyimli ellerde başarılı bir şekilde uygulanabilen morbidite ve mortalitesi laparotomiye kıyasla daha az olan, postoperatif daha kısa derlenme süresine ve daha iyi kozmetik sonuçlara sahip minimal invaziv bir işlemdir.

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