Abstract
PurposeHysterectomy alters the anatomy of the posterior vaginal vault used as access for transvaginal/transumbilical hybrid NOTES cholecystectomy (NC), creating potential consequences for the feasibility and complication rate of the procedure. Therefore, the aim of our retrospective analysis of prospectively collected data was to analyze the postoperative course after NC in previously hysterectomized (PH) patients compared with patients who had not undergone hysterectomy (NH).MethodsA total of 126 NH patients and 50 PH patients aged over 42 who had an NC from 12/2008 to 04/2021 were compared regarding age, body mass index (BMI), ASA classification, number of percutaneous trocars, need for intraoperative urinary bladder catheterization, length of procedure, conversion rate, and intraoperative and postoperative complication rate according to the Clavien/Dindo classification, Comprehensive Complication Index (CCI), mortality, and hospital length of stay.ResultsPH patients were older than NH patients (63.0 vs 51.5 years; P < 0.001) but did not differ significantly in ASA classification (P = 0.595) and BMI (26.8 vs 27.9 kg/m2; P = 0.480). They required more percutaneous trocars (P = 0.047) and longer procedure time (66.0 vs. 58.5 min; P = 0.039). Out of all 287 scheduled NC only one had to be “converted” to traditional laparoscopic cholecystectomy. Intraoperative and postoperative complication rates, Clavien/Dindo classification, CCI, need for intraoperative urinary bladder catheterization, and length of stay did not differ significantly.ConclusionOur results indicate an increased degree of difficulty of NC in PH patients, although there is no major impact on intraoperative and postoperative complication rates. Urinary bladder perforation is a specific access-related complication in PH patients.
Highlights
Traditional laparoscopic cholecystectomy (LC) is the gold standard in the treatment of gallstone disease in many countries
After excluding not undergone hysterectomy (NH) patients younger than 42, the median age in the control group was 51.5 years, which was still significantly lower than in the previously hysterectomized (PH) group, since the age distribution in the parallelized comparison group is significantly shifted to the left, as shown in Fig. 2c (Electronic Supplementary Material)
The other patient-side parameters of height, weight, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification were not significantly different (Table 1), so outcome parameters were analyzed between these two groups
Summary
Traditional laparoscopic cholecystectomy (LC) is the gold standard in the treatment of gallstone disease in many countries. Langenbeck's Archives of Surgery but rectal or urinary bladder injuries, for example, may occur [3] These complications are only expected after hysterectomy (PH), as the urinary bladder is otherwise separated from the posterior vaginal vault by the portio, cervix, and the uterus. To date, only one small case series describing transvaginal NOTES access after hysterectomy for gynecologic surgery predominantly for ovarian cysts has been published [4]. This issue has not yet been investigated for NOTES cholecystectomies. We comparatively analyze the data of our NC patients, stratified by their hysterectomy experiences, in order to detect differences in the intraoperative and postoperative course
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