Immediate and long-term results of treatment of abdominal complications after gynecological operations using endoscopic technologies

Abstract

The objective: to give a comparative assessment of the immediate and long-term results of laparoscopic treatment of postoperative abdominal complications in patients with gynecological pathology.Materials and methods. We carried out a comparative study of the immediate results after repeated laparoscopies and relaparotomies in gynecological patients with postoperative intra-abdominal complications, during which 2 clinical groups of patients were identified. Group I (main) consisted of 62 patients (50,82%) with early postoperative complications who underwent video endoscopic interventions. Group II (control) included 60 (49,18%) patients who underwent traditional «open» laparotomy. The criteria for the course of the early postoperative period were chosen traditionally. At the same time, it was taken into account that after the repeated interventions, the patients of both the main and the control groups received similar intensive therapy aimed at correcting the main symptom complex of the disease.All patients were comprehensively examined using clinical, instrumental and laboratory research methods. The groups were homogeneous in age and structure of operations performed on the pelvic organs, and were statistically comparable.Long-term results were studied among 28 (45,1%) patients of the main group and 21 women from the comparison group (35%) in terms of one to five years after gynecological intervention.Results. In the patients of the control group, the pain syndrome persisted statistically significantly longer and required prescription of anesthetic drugs on average 2 days more. The use of laparoscopy in the treatment of postoperative complications most often (51,7%) made it possible to refuse analgesics, and non-steroidal anti-inflammatory drugs were used on demand only in the first 2–3 days. The average duration of inpatient treatment for patients of group I with postoperative intra-abdominal gynecological complications averaged 10±2,5 days versus 16±2,9 in II (control) (p>0,05). The average duration of inpatient treatment after open surgery was on average 6±1,9 days longer (p<0,05).Long-term results were assessed using a three-point system (the result is good, satisfactory, unsatisfactory) based on the data of clinical and instrumental examination. Good long-term results were found in 13 (46,4%) patients of the main group and in 6 (28,5%) patients from the control group. Satisfactory results in group I were found in 13 (46,4%) patients, in group II – in 13, which amounted to 61,9%. In 2 patients, the results were found unsatisfactory after relaparoscopic manipulations (7,2%), and in 2 (9,5%) – after relaparotomy. One patient, due to frequent, recurrent cramping pains, was operated on as planned (abdominal adhesions were dissected).The study revealed a direct relationship during the early postoperative period and long-term results in women operated traditionally and with the use of laparoscopy. Based on the study of the results of surgical treatment of early postoperative intraperitoneal complications, the high efficiency of the video-laparoscopic method was proved in comparison with the traditional one. Thus, the implementation of the proposed treatment tactics can significantly improve the quality of life of this category of patients. The study of long-term results of laparoscopic operations has shown that the use of diagnostic methods of surgical techniques in the practice of medical institutions will contribute to the improvement of the results of complex treatment of sick women with pathology of the pelvic organs.