ÖzetAmaç: Günümüzde benign uterin patolojiler için abdominal histerektomi (AH), vajinal histerektomiden (VH) fazla yapılmaktadır. Total laparoskopik histerektomi (TLH) ise her iki yönteme nazaran daha kısa iyileşme süresi ve günlük hayata dönüşün hızlı olması nedeniyle daha yaygın yapılmaya başlanmıştır. Biz bu çalışmada kliniğimizde yapılan AH, VH ve TLH'ların sonuçlarını karşılaştırdık. Yöntem: Bu çalışmada Bağcılar EAH Kadın Doğum Kliniği'nde 2010 Aralık-2011 Aralık tarihleri arasında benign nedenlerle histerektomi yapılan olgular geriye dönük olarak karşılaştırıldı. Bu sürede 139 AH (%56.8), 61 VH (%24.9), 45 TLH (%18.3) yapılmıştı. Olguların yaşları, pariteleri, hastanede kalış süreleri, komplikasyonları, hematokrit değişiklikleri ve operasyon süreleri kaydedildi. İstatistik analizleri yapıldı. Bulgular: AH, VH, TLH'larda ortalama yaş sırasıyla 49.5, 59 ve 51,6 idi. Parite ortalaması sırasıyla 3, 4.5 ve 4.3'tü. Hastanede ortalama kalış süreleri 3.8, 3.8 ve 2.9 gün olarak bulundu. TLH olgularının operasyon süresi (139.27±36.48 dakika); AH (66.91±11.64 dakika) ve VH (47.50±9.68 dakika) grubundaki olguların operasyon süresinden anlamlı olarak uzun bulundu (p<0.01). Olguların hematokrit değişiklikleri benzer saptandı. TLH'larda komplikasyon oranı biraz daha yüksek bulundu. Sonuç: ABD'de halen histerektomilerin %70'e yakını abdominal olarak yapılmaktadır. ACOG tarafından birinci sırada VH, ikinci sırada TLH, son olarak AH'lerin tercih edilmesi önerilmiştir. Kliniğimiz yeni bir klinik olmasına rağmen VH ve TLH'ların toplamı AH'lere yakın olarak bulunmuştur. (Ha se ki T›p Bül te ni 2013; 51: 112-5) Anahtar Kelimeler: Histerektomi, endikasyonlar, post-operatif değişiklikler Abs tractAim: Lately, vaginal hysterectomies (VH) are being performed more frequently than abdominal hysterectomies (AH) for benign pathologies. Even then, total laparoscopic hysterectomy (TLH) has been widely done because of its shorter recovery time. In this study, we compared the results of AH, VH and TLH performed in our clinic. Methods:In this study, we retrospectively evaluated the hysterectomies performed between December 2010 and December 2011 for benign uterine pathologies in the Obstetric and Gynecology Clinic at Bağcılar Training and Research Hospital. It is a retrospective study. During this time, 139 AH (56.8%), 61 VH (24.9%), and 45 TLH (18.3%) were done. Data including age, parity, length of hospital stay, change in hematocrit, and length of the operations were recorded. Statistical analysis was performed.Results:The average age of patients who underwent AH, VH and TLH was 49.5.0, 59 and 51.6, respectively. The average parity was 3.0, 4.5 and 4.3, respectively. The average length of hospital stay was 3.8, 3.8, and 2.9 days, respectively. Duration of operation (139.27+/-36.48 min) in TLH group was longer than in AH (66.91+/-11.64 min) and VH groups (47.50+/-9.6 min) (p<0.01). Changes in hematocrit were similar in the groups. Complications related to TLH seem to be a little more than other procedures. Conclusion:Nearly 70% of all hys...
<p><strong>Objective:</strong> Endometriosis is a common gynecological condition that affects many women of reproductive age worldwide and is a major cause of pain and infertility. Treatment of endometriosis can be either surgical, aiming to restore normal anatomy by removing endometriotic lesions, or hormonal. Various medical treatments with different doses, formulations, delivery systems, and regimens have been tested. The main objective of this study was to compare the efficacy and tolerability of dienogest and dienogest plus ethinylestradiol on endometriosis-related pain. Additionally, the effects on endometrioma size were examined.</p><p><strong>Study Design:</strong> A total of 81 patients with clinically diagnosed endometrioma, who had chronic pelvic pain, dysmenorrhea, or deep dyspareunia between January 2015 and December 2018 were studied retrospectively. The patients were divided into two main groups: continuous oral dienogest (n=43) (Visanne®, 2 mg/day) and continuous oral dienogest plus ethinylestradiol (n=38) (Dienille®, 2 mg/0.03 mg/day). The intensity of pain symptoms was evaluated before therapy, then after 3 and 6 months of treatment using a 10-point numerical rating scale (0 = no pain and 10 = worst possible pain) (NRS) provided to the patients in advance.</p><p><strong>Results:</strong> The pain scores related to chronic pelvic pain decreased 36% for dienogest and 49% for dienogest plus ethinylestradiol (p<0.05) and scores for dysmenorrhea decreased 38% and 44% respectively (p<0.05) at 6 months, significantly lower than before treatment. At the 6-month follow-up, a 28% decrease in the pain scores related to deep dyspareunia in the dienogest group was statistically significant. Although the dienogest plus ethinylestradiol group also decreased by 20%, the difference was not significant. There was no significant difference in endometrioma size between the two groups at the 6-month follow-up (dienogest and dienogest plus ethinylestradiol; 24.2±17.5 mm vs. 27.5±19.1 mm, respectively; p=0.42).</p><p><strong>Conclusion:</strong> Upon analysis of our 6 months of clinical data, estrogen-progestin and a progestin alone seem to be of similar efficacy for the temporary treatment of endometriosis-related pain. The dienogest plus ethinylestradiol combination was slightly less effective on deep dyspareunia but was still well tolerated. Similarly, the two hormonal regimens posed no superiority over one another with regard to endometrioma size reduction.</p>
Background/Aims: The objective of this study was to compare the depth and width of thermal spread caused on rat uterine tissue after application of 3 different electrosurgical generators. Methods: Alsa Excell 350 MCDSe (Unit A), Meditom DT-400P (Unit M), and ERBE Erbotom VIO 300 D (Unit E) electrosurgical units (ESUs) were used. The number of Wistar Hannover rats required to obtain valid results was 10. The primary objective of the study was to compare the 3 ESUs using the same instrument and the same waveform. The secondary objective of the study was to compare the differences between monopolar and bipolar systems of each ESU separately using the same waveform. Results: The thermal spread caused by each ESU using monopolar instruments with continuous and interrupted waveforms was significantly different. Among the 3 devices, Unit A caused the largest thermal uterine tissue spread. On the other hand, Unit E caused the most superficial thermal tissue spread, and the smallest thermal spread among all ESUs. Conclusions: Surgeons should note that different ESUs used with the same power output might create different thermal effects especially in the monopolar configuration within the same waveform, for the same duration, and with the same instrument.
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