Çetin KILIÇÇI, EVRİM BOSTANCI ERGEN, Mesut POLAT, Ayşen BOZA TELCE, Çiğdem YAYLA ABİDE

Abdominal, vajinal ve total laparoskopik histerektominin maliyet etkinliklerinin ve klinik sonuçlarının seçili hasta grubunda karşılaştırılması

Amaç: Total laparoskopik histerektomi (TLH), total abdominal histerektomi (TAH) ve vajinal histerektominin (VH) perioperatif ve postoperatif sonuçlarını; seçili hasta grubunda karşılaştırmaktır.Gereç ve Yöntem: 223 histerektomi çalışmaya dahil edildi. Hastalar üç gruba ayrıldı. Grup 1'de TLH (n = 63); Grup 2'de TAH (n = 133), Grup 3 ise VH (n = 37) yapılan hastalardan oluşuyordu. Her üç grubun da benzer yaş, parite ve uterus boyutları vardı. Başlıca değerlendirilen ölçütler; ameliyat süresi, ateş, analjezi gereksinimi, hastanede kalış süresi, işe geri dönüş süresi, perioperatif ve postoperatif komplikasyonlar, kan transfüzyonu sayısı ve ameliyat masrafları idi.Bulgular: Operasyon süresi VH grubunda en kısa idi. Üç grup arasında hastanede kalış süreleri açısından anlamlı farklılık saptanmadı. VH en ucuz histerektomi tipiydi. VH grubu TLH grubuyla karşılaştırıldığında; analjezik gereksinimi ve işe geri dönüş süresi açısından istatistiki fark tespit edilmedi. VH grubunda; TAH (p = 0.001) ve TLH gruplarına kıyasla daha fazla kan transfüzyonu gerektiği saptandı(p <0.001). Sonuç: VH diğer iki teknik ile karşılaştırıldığında en kısa operasyon süresi ve en düşük cerrahi maliyete sahipken; benzer perioperatif ve postoperatif sonuçlar saptandı.

Anahtar Kelimeler:

laparoskopik histerektomi, abdominal histerektomi, vajinal histerektomi, maliyet etkinlik

Comparison of cost-effectivenes and clinical outcomes of abdominal, vaginal and total laparoscopic hysterectomy in a selected group

Objective: The aim was to compare the perioperative and postoperative outcomes of total laparoscopic hysterectomy(TLH), total abdominal hysterectomy(TAH), and vaginal hysterectomy(VH) in a selected group of patients.Materials and Methods: Two hundred twenty-three hysterectomies were included in this study. The patients were separated into three groups. Group1 included patients with TLH(n=63); TAH patients were placed in Group 2(n=133), and Group 3 was made up of patients who underwent VH(n=37). All three groups had similar ages, parities, and uterine sizes. The main outcome measures were operation time, fever, need for analgesia, duration of hospital survellience, return to work time, perioperative and postoperative complications, the number of blood transfusions, and costs of the surgery.Results: The total operation time was the shortest in the VH group. There was no significant difference in the hospital survellience duration between the three groups. The VH was found to be the cheapest type of hysterectomy. When the VH group was compared with the TLH group, there was no difference in the use of analgesics for postoperative pain or the time return to work. The VH group patients required more blood transfusions in contrast with the TAH(p=0.001) and TLH groups(p<0.001). Conclusion: VH had similar operative and postoperative outcomes but the shortest duration of operation and the lowest surgical cost compared with the other two techniques.

Keywords:

total laparoscopic hysterectomy, total abdominal hysterectomy, vaginal hysterectomy, cost-effectiveness,

PDF

___

1. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. American Journal of Obstetrics and Gynecology 2008; 198: 34.e1-.e7. doi: 10.1016/j.ajog.2007.05.039
2. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy Rates in the United States, 2003. Obstetrics & Gynecology 2007; 110: 1091-5. doi: 10.1097/01.AOG.0000285997.38553.4b
3. Reich H, DeCaprio J, McGlynn F. Laparoscopic Hysterectomy. Journal of Gynecologic Surgery 1989; 5: 213-6. doi: 10.1089/gyn.1989.5.213
4. BRILL AI. Hysterectomy in the 21st Century: Different Approaches, Different Challenges. Clinical Obstetrics and Gynecology 2006; 49: 722-35. doi: 10.1097/01.grf.0000211946.51712.42
5. Clayton RD. Hysterectomy. Best practice & research Clinical obstetrics & gynaecology 2006; 20: 73-87. doi: 10.1016/j.bpobgyn.2005.09.007
6. Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, et al. Surgical approach to hysterectomy for benign gynaecological disease. In: Kluivers K, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2006. p. CD003677.
7. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed) 2005; 330: 1478. doi: 10.1136/bmj.330.7506.1478 8. Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ (Clinical research ed) 2004; 328: 129. doi: 10.1136/bmj.37984.623889.F6 9. Soriano D, Goldstein A, Lecuru F, Daraï E. Recovery from vaginal hysterectomy compared with laparoscopy-assisted vaginal hysterectomy: a prospective, randomized, multicenter study. Acta obstetricia et gynecologica Scandinavica 2001; 80: 337-41.
10. Daraï E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstetrics and gynecology 2001; 97: 712-6.
11. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2003; 83: 37-43.
12. Summitt RL, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstetrics and gynecology 1992; 80: 895-901.
13. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. The Cochrane database of systematic reviews 2009: CD003677. doi: 10.1002/14651858.CD003677.pub4 14. Allam IS, Makled AK, Gomaa IA, El Bishry GM, Bayoumy HA, Ali DF. Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial. Archives of gynecology and obstetrics 2015; 291: 1341-5. doi: 10.1007/s00404-014-3571-3
15. Hwang J-L, Seow K-M, Tsai Y-L, Huang L-W, Hsieh B-C, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study. Acta obstetricia et gynecologica Scandinavica 2002; 81: 1132-8.
16. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG : an international journal of obstetrics and gynaecology 2000; 107: 1380-5.
17. Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, et al. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Archives of gynecology and obstetrics 2014; 290: 485-91. doi: 10.1007/s00404-014-3228-2
18. Sesti F, Calonzi F, Ruggeri V, Pietropolli A, Piccione E. A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2008; 103: 227-31. doi: 10.1016/j.ijgo.2008.07.006
19. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Human reproduction (Oxford, England) 2001; 16: 1473-8. 20. Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG : an international journal of obstetrics and gynaecology 2009; 116: 492-500. doi: 10.1111/j.1471-0528.2008.01966.x
21. Walsh CA, Walsh SR, Tang TY, Slack M. Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: A meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2009; 144: 3-7. doi: 10.1016/j.ejogrb.2009.01.003
22. Young W, Cohen MM. Laparoscopically assisted vaginal hysterectomy. A review of current issues. International journal of technology assessment in health care 1997; 13: 368-79.
23. Doğanay M, Yildiz Y, Tonguc E, Var T, Karayalcin R, Eryılmaz OG, et al. Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity. Archives of gynecology and obstetrics 2011; 284: 385-9. doi: 10.1007/s00404-010-1678-8
24. Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 148: 172-6. doi: 10.1016/j.ejogrb.2009.10.019
25. Lenihan JP, Kovanda C, Cammarano C. Comparison of laparoscopic-assisted vaginal hysterectomy with traditional hysterectomy for cost-effectiveness to employers. American journal of obstetrics and gynecology 2004; 190: 1714-20; discussion 20-2. doi: 10.1016/j.ajog.2004.02.059