Untersuchungen zur Lebensqualität und gynäkologisches Follow-up nach transvaginaler Cholezystektomie

Abstract

It has been reported recently that transvaginal cholecystectomy (TV‑ChE) has advantages over ‘classic’ laparoscopic cholecystectomy (LAP‑ChE) because of its minimal invasiveness. TV‑ChE seems to be associated with a lesser need for analgesics and faster reconvalescence of patients. However, substantial doubts about the transvaginal access and possibly associated complaints and complications of the procedure have been raised. PATIENT/MATERIAL AND METHODS: In this prospective case-control study 30 female patients undergoing transvaginal cholecystectomy (TV‑ChE group) have been compared with 30 women undergoing conventional laparoscopic cholecystectomy (LAP‑ChE group). Female patients were evaluated with special regard to health-related quality of life, outcome data such as surgical complications and gynaecological complaints and changes in sexual behaviour after surgery. Additional attention was given to the extent of postoperative pain, the analgesic consumption and the rate of postoperative nausea and vomiting (PONV). The demographic data of both groups were comparable to a great extent. Compared to the LAP‑ChE group women of the TV‑ChE group reported less postoperative pain, less PONV and a lower analgesic consumption (p < 0.001). There were no serious complications in the LAP‑ChE group and also none in the TV‑ChE group. In comparison with the preoperative status, the results regarding health-related quality of life and feeling of well-being were significantly better for both groups after a follow-up of 12 months (p < 0.01). However, this effect was especially pronounced in the TV‑ChE group (p < 0.05). No infections of the surgical wound, wound healing problems or other complications were seen in the gynaecological follow-up examination 3 weeks after the TV‑ChE. Two women reported slight and temporary colpotomy-related complaints without any consequences for their sexual behaviour. The transvaginal cholecystectomy is a safe and less invasive surgical technique providing for an excellent patient comfort and a fast reconvalescence. TV‑ChE has a positive longterm effect on health-related quality of life. Doubts about transvaginal approach of this surgical technique with regard to an increased risk of infection or late gynaecological complications appear to be unfounded.