Ceren YILDIZ EREN, Özlem ÖZGÜR GÜRSOY, Hulusi Göktuğ GÜRER, Ramazan BAYIRLI

EVRE 3 - 4 ADEZYONU OLAN OLGULARDA LAPAROSKOPİK HİSTEREKTOMİ OPERASYONLARININ KLİNİK DEĞERLENDİRMESİ: ESKİŞEHİR DENEYİMİ

AMAÇ: Total laparoskopik histerektomi (TLH) yapılan ve evre 3 - 4 adezyonu olan 35 hastanın retrospektif değerlendirilmesi amaçlanmıştır.GEREÇ VE YÖNTEM: Ocak 2017 ve Haziran 2020 arasında benign endikasyonlar nedeniyle TLH uygulanan 155 olgudan evre 3 - 4 adezyonu olan 35 olgu çalışmaya dahil edildi. Demografik özellikleri, histerektomi endikasyonları, uterus ağırlıkları, intraoperatif ve postoperatif komplikasyonları, operasyon süresi, hastanede kalış süresi ve kan kaybı retrospektif olarak değerlendirildi. Komplikasyonlar literatüre uygun olarak majör komplikasyonlar, minör komplikasyonlar ve total komplikasyonlar olarak sınıflandırıldı.BULGULAR: Hastaların yaş ortalaması 49,6±6,4 (37 - 63), parite ortalaması 1,8±0,9 (0 - 4) ve vücut kitle indeksi ortalaması 27,6 ± 5,8 (18-39) kg/m2 idi. Operasyon sırasında yapılan değerlendirme skorlamasına göre hastaların adezyon evresi ortalama 3,3 ±0,4 (3 - 4) olarak bulundu. Vakaların %51,4'ünde (18/35), adezyon oluşumunun nedeni olarak geçirilmiş intraperitoneal cerrahi gösterildi. Diğer vakalarda endometriozis ve pelvik enflamatuar hastalık, adezyon nedenleri olarak düşünüldü. Postoperatif değerlendirmede uterus ağırlığı ortalaması 264,7±201,9 g (80-1075 g), operasyon süresi ortalaması 108,4±24,9 dk. (65-175 dk.), hastanede ortalama yatış süresi 3,2 ±1,4 gün (2-9 gün) ve ortalama total kan kaybı 285,7±144,4 ml (100-800 ml) olarak bulundu. Majör komplikasyon oranı %8,5 (3/35), minör komplikasyon oranı %8,5 (3/35) ve toplam komplikasyon oranı %17,1 (6/35) olarak saptandı.SONUÇ: TLH, benign jinekolojik vakalarda iyi bir cerrahi tercih olsa da, ileri evre intra-peritoneal adezyonu olan olgularda komplikasyon oranlarının yüksek olduğu akılda tutulmalıdır. Bu hastalar yeterince bilgilendirilmeli ve olası komplikasyonlar gözönünde bulundurularak TLH planlanmalıdır.

Anahtar Kelimeler:

total laparoskopik histerektomi, adezyon, komplikasyonlar

CLINICAL EVALUATION OF TOTAL LAPAROSCOPIC HYSTERECTOMY CASES WITH GRADE 3 - 4 ADHESIONS: ESKİSEHİR EXPERIENCE

OBJECTIVE: This study aims to evalute the clinical results of 35 cases that underwent total laparoscopic hysterectomy (TLH) and had grade 3 - 4 adhesions.MATERIAL AND METHODS: This is a retrospective study of 35 TLH cases with grade 3 - 4 adhesions out of 155 TLH operations performed for benign indications between January 2017 and July 2020. Data related with the demographic characteristics, hysterectomy indications, uterine weight, intraoperative and postoperative complications, duration of the operation, length of hospital stay and amount of blood loss were noted. Complications were classified as major, minor, and total complications according to the literature.RESULTS: The mean age, parity and body mass index of the patients were 49,6±6,4 (37-63) years; 1,8±0,9 (0-4) and 27,6 ± 5,8 (18 - 39) kg/m2 respectively. The mean adhesion score defined during operation was grade 3,3 ±0,4 (3 - 4). The most common reason of adhesions was the history of abdominal surgery which was observed in %51,4 of cases (18/35). In the remaining cases, endometriosis and pelvic inflammatory disease were defined as the reasons of adhesions. The mean uterine weight, operative time, length of hospital stay and amount of blood loss were 264,7±201,9 g (80-1075 g), 108,4±24,9 min (65 - 175 min), 3,2 ±1,4 days (2-9 days) and 285,7±144,4 ml (100-800 ml) respectively. Total, major and minor complication rates were %17,1 (6/35), %8,5 (3/35) and 8.5% (3/35) respectively.CONCLUSIONS: Although TLH is a well- designed surgical procedure for the management of benign gynecological conditions, patients with high grade intraperitoneal adhesions have still higher complication rates. These patients should be informed adequately and TLH should be planned in consideration of possible complications.

Keywords:

Total laparoscopic hysterectomy, Adhesion, Complication,

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