Jinekolojide laparoskopik cerrahi: Diagnostik ve operatif laparoskopi uygulanan 395 olgunun retrospektif analizi

Laparoscopic surgery in gynecology: A retrospective analysis of 395 patients with diagnostic and operative procedures

Sebiha ÖZKAN, Eray ÇALIŞKAN, Semih ÖZEREN, Ebru COŞKUN, Aydın ÇORAKÇI, İzzet YÜCESOY

Özet

Amaç: Jinekolojide uygulanan diagnostik ve operatif laparoskopik girişimlerin klinik endikasyonlarının ve komplikasyonlarının değerlendirilmesi Materyal ve Metod: Kocaeli Üniversitesi Kadın Hastalıkları ve Doğum Kliniği’nde Ağustos 1997-Ağustos 2002 tarihleri arasında gerçekleştirilen 395 diagnostik ve operatif laparoskopik (L/S) girişim retrospektif olarak değerlendirildi. Olguların demografik özellikleri, L/S’nin klinik endikasyonları ve assosiye perioperatif komplikasyonları gözden geçirildi. Bulgular: Hastaların yaş ortalamaları 32.124 (18-52), ortalama hastanede kalma süreleri

Abstract

Objective: To evaluate the clinical indications and associated complications of laparoscopic (L/S) procedures in gynecology Materials and Methods: A retrospective study was carried on 395 diagnostic and operative laparoscopic cases performed between August 1997-August 2002 at Kocaeli University School of Medicine, Department of Obstetrics and Gynecology. Patient characteristics, clinical indications and associated perioperative complications were reviewed. Results: The mean age of the patients was 32.124 and the mean hospital stay was less than 2 days. Of 395 procedures 130 cases were diagnostic (32.91%) while operative L/S was performed in 265 patients (67.088%). The majority of all cases appeared to be primary infertility (n: 121, 30.63%) while secondary infertility cases made 9.367% of the patients with 37 cases. Chronic pelvic pain was the indication of 15 cases (3.797%), uterine malformation in 9 cases (2.278%), primary amenorrhea in 5 cases (1.265%), secondary amenorrhea in 6 cases (1.518%) and habitual abortus in 6 cases (1.518%). Types of L/S surgery performed were bilateral tubal ligation (n: 99, 37.358%), adhesiolysis (n: 46, 17.358%), cauterization of endometriosis implants (n: 22, 8.301%), L/S for ectopic pregnancy (n: 16, 6.037%), ovarian drilling in polycystic ovarian syndrome (n: 12, 4.528%), ovarian cyst aspiration (n: 7, 2.641%). The mean operation time differed in the range of 30-120 minutes. Perioperative complications included 10 cases of conversion to laparotomy because of technical problems, dense intraabdominal adhesions, unsuccesful L/S, incompleted hemostasis after myomectomy, 1 case of subcutaneous emphysema, 1 case of allergic reaction to methylene blue, 1 case of trocar site bleeding, 2 cases of uterine perforation (cases of combined H/S and L/S). Conclusion:L/S procedures seem to be treatment of choice for a number of indications in gynecology. Avoiding laparotomy, smaller incisions, less preioperative discomfort, minimal tissue trauma, shorter hospital stay are well known advantages. Nevertheless careful patient selection is mandatory to avoid potentially serious perioperative complications.