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Gitte Bennich Mohamed Khalil Benny Kirschner

Gitte Bennich Mohamed Khalil Benny Kirschner. Vaginal VS Laparoscopic Hysterectomy. CASE. 45årig pt. Menometrorhagi Uterus let fibromatøst forstørret GU; cystoc. gr.1.,-rectoc.,-descens. Tidl.; GII, PII, sectio x1, vag., x1 BMI 30. PICO. P hysterectomi benign indik., <300g

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Gitte Bennich Mohamed Khalil Benny Kirschner

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  1. Gitte BennichMohamed KhalilBenny Kirschner Vaginal VS Laparoscopic Hysterectomy

  2. CASE 45årig pt. Menometrorhagi Uterus let fibromatøst forstørret GU; cystoc. gr.1.,-rectoc.,-descens. Tidl.; GII, PII, sectio x1, vag., x1 BMI 30

  3. PICO P hysterectomi benign indik., <300g I Vaginal hysterektomi C Laparoskopisk hysterektomi O Komplikationer, knivtid

  4. Litteratursøgning Søgeord • Vaginal hysterectomy • Laparoscopic hysterectomy (incl.total) • Complications Limits: Sidste 3 år, engelsk, RCT, Meta, Review, CT MeSH og fritekst Cochrane - 1 relevante hits (publ. 2006) PubMed - 0 relevante hits (ældre end Cochrane) Related artcles – 2 relevante hits

  5. Udvælgelseskriterier Evidensgradering

  6. Cochrane • Publ. 2006 (1966-2004) • Surgical approach to hysterectomy for benign gynaecological disease • Baseret på RCT, 27 stk. • 3643 pt. • Endpoints; Op.tid, Complication • Vaginal (VH), Abd. (AH), Lap. (LH) • Vaginal vs. Lap.; Ingen fordele ved Lap. Øget op.tid(41,5min.) VH fremfor Lap., når dette er muligt. Når VH ikke er muligt, da LH fremfor AH (NB Op.tid) Yderligere forskning er nødvendigt

  7. Human Reproduction • Publ. 2007, Fr., Jun.-Dec.2004, 12 afd. • Surgical routes and complications of hysterectomy for benign disorders […] • 634 pt. (vag. 306, lap.321) • Endpoint: Op.tid, Komplikasioner (tarmlesion, blødning, urinvejslesion, postop.) • VH vs. LH: Op.kortere ved VH Flere komplikatiner ved VH (8.2% vs. 5.8%) Lengere postop. indl. ved LH (4.6dg vs. 1.5d) Der kan ikke drages sikre konklusioner fra aktuelle studie, ”there is a place for all surgical routes”.

  8. BJOG • Publ. 2008 • A series of 3190 laparoscopic hysterectomies for benign disease frm 1990 to 2006 […] • 4505 pt. (3190 LH, 903 VH, 409 AH) • Endpoint: Komplikationer • Force: Alle operationer foretaget af det samme team • VH vs. LH: Ingen forskel mht komplikationer (1%) Alle op. metoder har sine fordele og plads i sortimentet. Yderligere forskning er nødvendigt. Er yderligere RCT nødvendigt for at vise fordelene ved LH, da der ses major complicationrate på kun 0.45%

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