Abstract:

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: