Emergency treatment in gynecology using different methods of surgery
The aim. Improving surgical treatment of urgent genital pathology based on comparing the effectiveness of different methods of surgery.
Materials and methods. 170 women were selected and divided into three groups. Group 1 included women with acute pelvic inflammatory disease (aPID); to 2nd group – 60 women with intra-abdominal bleeding (IAB); to 3rd group - 50 women with impaired blood supply to tumors of the internal genitalia (uterus and ovaries) (IBSTIG). Each group was divided into two equivalent subgroups depending on the method of treatment: laparoscopic or laparotomy.
During the study, all examined patients had a medical history, gynecological examination, ultrasound examination, surgical treatment by laparoscopy or laparotomy.
Results. The average duration of laparoscopic operations in patients in subgroup 1.1 was 50.4±7.2 minutes and 80.3±10.1 minutes in subgroup 1.2 – with laparotomy method. Intraoperative blood loss was significantly lower in subgroup 1.1 compared with subgroup 1.2 (210.7±31.4 ml and 375.9±44.5 ml) (p <0.01). In the postoperative period in subgroup 1.1, which included women with emergencies due to aPID and in which operations were performed laparoscopically, the maximum temperature rise after surgery was 37.6±0.04 °C, which was significantly lower than in subgroup 1.2, which included women with emergencies due to aPID and in which operations were performed by laparotomy, this figure was 38.0±0.08 °C (p <0.001). The mean duration of the postoperative period in patients of subgroup 1.1 was significantly shorter compared to subgroup 1.2 (7.2±0.6 and 10.2±1.0 days) (p <0.05).
The average duration of operations in subgroup 2.1 was significantly shorter than in subgroup 2.1 (39.8±2.1 and 59.1±2.5 minutes, respectively) (p <0.001). Intraoperative blood loss was on average significantly lower in subgroup 2.1 (189.1±19.8 and 388.5±37.2 ml, respectively) (p <0.05).
In subgroup 3.1, which included women with IBSTIG and underwent surgical treatment by laparoscopy, the average duration of operations was significantly shorter than in subgroup 3.2, where such women with such pathology received surgical treatment by laparotomy (62.1±4.9 and 89.6±7.8 minutes, respectively) (p <0.01). Blood loss was significantly lower in subgroup 3.1 in contrast to subgroup 3.2 (101.7±10.1 ml and 283.3±12.9 ml, respectively) (p <0.001).
Conclusions. The use of laparoscopy for the treatment of urgent genital pathology could increase the effectiveness of surgical treatment. In addition, this method reduces the duration of surgery and surgical blood loss. As a result, it makes it possible to improve the postoperative period.
Lawani, O. L., Anozie, O. B., Ezeonu, P. O. (2013). Ectopic pregnancy: a life-threatening gynecological emergency. International Journal of Women's Health, 5, 515–521. doi: http://doi.org/10.2147/ijwh.s49672
Kalogera, E., Bakkum-Gamez, J. N., Jankowski, C. J., Trabuco, E., Lovely, J. K., Dhanorker, S. et. al. (2013). Enhanced Recovery in Gynecologic Surgery. Obstetrics & Gynecology, 122 (2), 319–328. doi: http://doi.org/10.1097/aog.0b013e31829aa780
Thepsuwan, J., Huang, K.-G., Wilamarta, M., Adlan, A.-S., Manvelyan, V., Lee, C.-L. (2013). Principles of safe abdominal entry in laparoscopic gynecologic surgery. Gynecology and Minimally Invasive Therapy, 2 (4), 105–109. doi: http://doi.org/10.1016/j.gmit.2013.07.003
Alobaid, A., Memon, A., Alobaid, S., Aldakhil, L. (2013). Laparoscopic Management of Huge Ovarian Cysts. Obstetrics and Gynecology International, 2013, 1–4. doi: http://doi.org/10.1155/2013/380854
Rana, P., Kazmi, I., Singh, R., Afzal, M., Al-Abbasi, F. A., Aseeri, A. et. al. (2013). Ectopic pregnancy: a review. Archives of Gynecology and Obstetrics, 288 (4), 747–757. doi: http://doi.org/10.1007/s00404-013-2929-2
Elson, C. J., Salim, R., Potdar, N., Chetty, M., Ross, J. A., Kirk, E. J. (2016). Diagnosis and management of ectopic pregnancy. BJOG: An International Journal of Obstetrics and Gynaecology, 123 (13), e15–e55. doi: http://doi.org/10.1111/1471-0528.14189
Carrascosa, P., Capuñay, C., Sueldo, C. E., Baronio, J. M. (2014). Tubal pathology. CT Virtual Hysterosalpingography. Cham: Springer, 191–202. doi: http://doi.org/10.1007/978-3-319-07560-0_9
Göksever Çelik, H., Çelik, E., Yüksel, S., Baştu, E., Ark, H. C. (2017). Different Surgical Techniques in Tubo-ovarian Abscess Management. Gynecology Obstetrics & Reproductive Medicine, 23 (1), 32–36. doi: http://doi.org/10.21613/gorm.2016.639
Kim, H. Y., Yang, J. I., Moon, C. (2014). Comparison of severe pelvic inflammatory disease, pyosalpinx and tubo-ovarian abscess. Journal of Obstetrics and Gynaecology Research, 41 (5), 742–746. doi: http://doi.org/10.1111/jog.12617
Ross, J., Chacko, M. (2019). Pelvic inflammatory disease: Clinical manifestations and diagnosis. Available at: https://www.uptodate.com/contents/pelvic-inflammatory-disease-clinical-manifestations-and-diagnosis
Jiang, X., Shi, M., Sui, M., Wang, T., Yang, H., Zhou, H., Zhao, K. (2019). Clinical value of early laparoscopic therapy in the management of tubo‑ovarian or pelvic abscess. Experimental and therapeutic medicine, 18 (2), 1115–1122. doi: http://doi.org/10.3892/etm.2019.7699
Snyman, L., Makulana, T., Makin, J. D. (2017). A randomised trial comparing laparoscopy with laparotomy in the management of women with ruptured ectopic pregnancy. South African Medical Journal, 107 (3), 258–263. doi: http://doi.org/10.7196/samj.2017.v107i3.11447
Eltabbakh, G. H., Charboneau, A. M., Eltabbakh, N. G. (2008). Laparoscopic surgery for large benign ovarian cysts. Gynecologic Oncology, 108 (1), 72–76. doi: http://doi.org/10.1016/j.ygyno.2007.08.085
Joo, J., Moon, H. K., Moon, Y. E. (2019). Identification of predictors for acute postoperative pain after gynecological laparoscopy (STROBE-compliant article). Medicine, 98 (42), e17621. doi: http://doi.org/10.1097/md.0000000000017621
Alkatout, I., Honemeyer, U., Strauss, A., Tinelli, A., Malvasi, A., Jonat, W. et. al. (2013). Clinical Diagnosis and Treatment of Ectopic Pregnancy. Obstetrical & Gynecological Survey, 68 (8), 571–581. doi: http://doi.org/10.1097/ogx.0b013e31829cdbeb
Kirk, E., Bottomley, C., Bourne, T. (2013). Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction Update, 20 (2), 250–261. doi: http://doi.org/10.1093/humupd/dmt047
Schwenkglenks, M., Gerbershagen, H. J., Taylor, R. S., Pogatzki-Zahn, E., Komann, M., Rothaug, J. et. al. (2014). Correlates of satisfaction with pain treatment in the acute postoperative period: Results from the international PAIN OUT registry. Pain, 155 (7), 1401–1411. doi: http://doi.org/10.1016/j.pain.2014.04.021
Jarrell, J., Ross, S., Robert, M., Wood, S., Tang, S., Stephanson, K., Giamberardino, M. A. (2014). Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain. American Journal of Obstetrics and Gynecology, 211 (4), 360.e1–360.e8. doi: http://doi.org/10.1016/j.ajog.2014.04.010
Ding, D.-C., Huang, C., Hong, M.-K. (2017). A review of ovary torsion. Tzu Chi Medical Journal, 29 (3), 143–147. doi: http://doi.org/10.4103/tcmj.tcmj_55_17
Asfour, V., Varma, R., Menon, P. (2015). Clinical risk factors for ovarian torsion. Journal of obstetrics and gynaecology, 35 (7), 721–725.
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