Wie sicher ist die laparoskopisch assistierte vaginale Hysterektomie?

 

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Zusammenfassung

Die Hysterektomie stellt eine sehr häufig durchgeführte Operation dar. Trotz bewiesener Nachteile der abdominalen Hysterektomie im Vergleich zur vaginalen Hysterektomie wird die abdominale Hysterektomie oft indiziert, obwohl die laparoskopisch assistierte Hysterektomie als zusätzliche Alternative zur Verfügung steht. Fragestellung: Wie hoch sind die Komplikationsraten bei der laparoskopisch assistierten vaginalen Hysterektomie und haben sie sich den Komplikationsraten der reinen vaginalen Hysterektomie angeglichen? Material und Methodik: Zwischen Juli 1994 und Juni 2003 wurden die Krankenakten aller Patientinnen, die sich einer vaginalen oder laparoskopisch assistierten vaginalen Hysterektomie ohne gleichzeitige Deszensuskorrektur in einer Ausbildungsklinik unterzogen hatten, retrospektiv ausgewertet. Studienendpunkte waren die Operationsdauer, die Rate intraoperativer Komplikationen und die Raten größerer und kleinerer postoperativer Komplikationen. Zur statistischen Auswertung wurde der exakte Test nach Fisher, der Student-t-Test und der Mann-Whitney U-Test verwendet. Ergebnisse: Patientinnen, die sich einer laparoskopisch assistierten vaginalen Hysterektomie unterzogen hatten (n = 929), waren signifikant älter, hatten einen ungünstigeren BMI, eine schwerere Gebärmutter und häufigere Zusatzoperationen als Patientinnen, die rein vaginal operiert worden waren (n = 735) (p < 0,001). Trotzdem unterschieden sich die Komplikationsraten nicht. Im Zusammenhang mit der laparoskopisch assistierten vaginalen Hysterektomie kam es zu signifikant weniger Revisionen und Temperaturerhöhungen durch Stumpfinfiltrate (p < 0,05). Schlussfolgerung: In dieser Untersuchungsreihe war die Rate intra- und postoperativer Komplikationen niedrig und unterschied sich nicht signifikant vom rein vaginalen Vorgehen.

Abstract

Background: Despite the proven advantages of vaginal hysterectomies compared to abdominal hysterectomies the latter is still very common for the therapy of benign disorders, although it could be replaced by laparoscopically assisted vaginal hysterectomy. The aim of this study is to describe the rate of complications in laparoscopically assisted vaginal hysterectomy in a teaching hospital and to compare it with the rate of complications in vaginal hysterectomies. Methods: Between July 1994 and June 2003 hospital records of patients who underwent hysterectomy (classical vaginal or laparoscopically assisted vaginal) without vaginal repair were evaluated retrospectively. Study end points were duration of surgery, hemoglobin difference, rate of intra- and postoperative complications. Fisher's exact test, Student's t-test, and Mann-Whitney U test were used for analysis. Results: Patients who underwent laparoscopically assisted vaginal hysterectomy (n = 929) were significantly older, had a higher BMI, and a higher uterine weight than patients undergoing vaginal hysterectomy (n = 735) (p < 0.001). Adnexal pathology was more often associated with a laparoscopic approach. The rate of complications did not differ between the groups, despite more difficult cases occurring in the group of laparoscopically assisted vaginal hysterectomies. Laparoscopically assisted vaginal hysterectomy was significantly associated with a lower incidence of fever related to operative site (p < 0.05), and a lower incidence of re-operation (p < 0.05). Conclusion: In this study the rate of intra- and postoperative complications in laparoscopically assisted vaginal hysterectomies was low and did not differ from that of vaginal hysterectomies in our teaching hospital.

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Dr. med. Chr. Altgassen

Universitätsfrauenklinik
Universitätsklinikum Schleswig-Holstein
Campus Lübeck

Ratzeburger Allee 160

23538 Lübeck

Email: altgassen@frauenklinik.uni-luebeck.de