Abstract

*Dr. Japaridze Marika and Gvenetadze Arsen

ABSTRACT

Introduction: Hysterectomy is the second most common gynecological operation after Caesarian section worldwide, with up to 600. 000 performed in the US per year.[1] There are three main surgical techniques of hysterectomy - traditional open, vaginal and laparoscopic. Since the implementation of mini-invasive methods of hysterectomy, many researches have proved advantages of vaginal and laparoscopic techniques to traditional open surgery.[2,3,4,5] However, comparison of laparoscopic and vaginal methods, their post-surgical rehabilitation process and quality of life are still subjects of interest. Aim: The aim of the study was to compare postoperative pain after laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in morbidly obese patients (BMI ? 35kg/m2). Methods: For this purpose, a multi-center prospective research was conducted in patients with benign pathologies and uterine size up to 15 weeks of gestation, who underwent laparoscopic and vaginal hysterectomy. Patients operated with the diagnosis of uterine prolapse were excluded from the research. The study was conducted for the period of January 2014 – November 2017. Totally 68 patients were studied and divided into two groups: laparoscopic hysterectomy (LH, n=32) and vaginal hysterectomy (VH, n=36). In both groups were analyzed: 1) length and frequency of medication with narcotics post-surgically, in terms of equal dosage and similarity of drugs; 2) pain intensity in 24 hours from the surgery, by means of the questionnaires Visual Analogue Scale (VAS), which were filled by patients after written consent. In LH and VH groups 28 and 31 patient respectively filled the questionnaire. Results: 1. Patients after VH needed narcotics for pain relief much often, than after LH (61, 11% and 15,63% respectively) (P0.05).Conclusion: According to the study, it may be concluded that in morbidly obese patients (BMI ?35 kg/m2) pain is more intense and lasts longer after vaginal hysterectomy, compared to laparoscopic hysterectomy. However, in 24 hours after the surgery pain is similar.