Jinekolojik laparoskopide veres sonrası kapalı trokar ile açık giriş tekniğinin etkinlik komplikasyon ve postoperatif ağrı açısından karşılaştırılması: prospektif çalışma *

Comparison of after veres closed trocar and open entry methods in terms of efficiency, complications and postoperative pain in gynecologic laparoscopy: prospective study

Özet

Amaç: Bu çalışmada, benign jinekolojik patolojiler için yapılan laparoskopik operasyonlarda batına girmek için uygulanan, veres sonrası kapalı trokar tekniği ile açık giriş tekniği, etkinlik, perioperatif özellikler, komplikasyonlar, postoperatif ağrı skalası ve analjezik ihtiyaçları açısından karşılaştırıldı. Yöntemler: Prospektif olarak yapılan çalışmaya Şırnak İdil Devlet Hastanesi ve Universal Malatya hastanesi jinekoloji kliniğine başvuran 213 hasta dahil edildi. Peritoneal kaviteye girişte 152 hastaya veres sonrası kapalı trokar tekniği (Grup 1), 61 hastaya ise açık giriş tekniği (Grup 2) uygulanmıştır. Bulgular: Her iki hasta grubunda yaş, BMI, parite gibi bazal değerlendirmeler açısından fark izlenmedi. Toplam operasyon süresi her iki grupta ben- zerdi (p=0.085). Grup 1de operasyona başlamak için geçen süre Grup 2den uzun bulundu (p=0.036). Perioperatif komplikasyonlar açısından değer- lendirildiğinde Grup 1de peritoneal kaviteye ilk girişte başarısızlık (p=0.023) ve preperitoneal insuflasyon (p=0.028) Grup 2den fazla izlendi. Grup 2de ameliyat konforunu bozan gaz kaçağı daha fazla bulundu (p=0.016). Grup 1de hemoglobin düşüşü Grup 2den daha düşük bulundu (p=0.048). Minör hematom, yara yeri enfeksiyonu, ürolojik yaralanma, paralitik ileus açısından karşılaştırıldığında her iki grupta fark izlenmedi. Operasyondan sonra ba- kılan 6. ve 24.saat VAS skorları (3.1e karşı 3.4; 2.1e karşı 2.5) ve analjezik ihtiyacı karşılaştırıldığında grup 1 ile grup 2 arasında fark izlenmedi (p=1.27). Sonuç: Her iki tekniğin birbirine mutlak üstünlüğü olmamakla birlikte, avantajlarının ve dezavantajlarının olduğu görüldü. Cerrahın deneyimine ve alışkan olduğu tekniğe göre her ikisinin de tercih edilebileceği sonucuna varıldı.

Abstract

Objective: It has been aimed to compare after veres closed trocar and open entry techniques in laparoscopic surgery performed for benign gyneco- logical pathologies, in terms of peri-operative characteristics, complications, postoperative pain scales and analgesic requirements. Methods: Two hundred and thirteen patients who applied to the gynecology outpatient clinics of Sirnak Idil State Hospital and Universal Malatya Hospital were included in the prospective study. After entry into the peritoneal cavity, after veres closed trocar technique was used for 152 of these patients (Group 1), open entry technique was used for 61 of these patients (Group 2). The duration until the operation, total operating time, periop- erative and postoperative complications were recorded. At the end of the postoperative 6th and 24th hours, the pain status of the patients was scored by applying VAS, and analgesic requirement was evaluated Results: In both groups, there was no difference in terms of baseline assessments such as age, BMI, parity. Total operating time was similar in both groups (p=0.085). The duration passing until the operation was longer in Group 1 than in Group 2 (p=0.036). In terms of perioperative complications, the failure in first entry into the peritoneal cavity (p=0.023) and preperitoneal insufflation (p=0.028) were higher in Group 1 than Group 2. Gas leak that disrupts the comfort of surgery was found higher in Group 2 (p=0.016). Decrease in hemoglobin was found lower in Group 1 than Group 2 (p=0.048). There was no difference seen in the comparasion of both two techniques in terms of minor hematoma, wound infection, urologic injury and paralytic ileus. When VAS scores were checked after the operation at the 6th and 24th hours (3.1-3.4; 2.1-2.5) and analgesic requirements were compared, there was no difference between Group 1 and Group 2 (p=1.27). Conclusion: The failure of a single entry, preperitoneal insufflation, andintestinal damage were seen higher in after Veres trocar entry than open entry. Operating times were similar, but the duration passing until the operation was found shorter for open entry. There was no significant difference in terms of minor hematoma, paralytic ileus, wound infection and urologic injury for both techniques. Decrease in hemoglobin was observed greater in open entry technique. There was no significant difference between the two groups in terms of VAS scores evaluated at the end of the postoperative 6th and 24th hours and analgesic requirement provided by ketoprofen. As a result, there were advantages and disadvantages of both techniques. There is no absolute superiority of either techniques. According to the experience and habit of the surgeon, both can be preferred.