Subject(s)
Contraceptive Agents, Female/adverse effects , Contraceptive Devices, Female/adverse effects , Desogestrel/adverse effects , Patient Satisfaction , Postpartum Period/psychology , Amenorrhea/etiology , Contraceptive Agents, Female/administration & dosage , Desogestrel/administration & dosage , Female , Humans , Menstrual Cycle/drug effects , Postpartum Period/physiologyABSTRACT
OBJECTIVE: To compare the surgical outcomes of laparoscopic hysterectomy (LH) versus abdominal hysterectomy (AH) in patients with severe pelvic endometriosis. METHODS: A retrospective review of patients undergoing hysterectomy for endometriosis was conducted between January 2002 and December 2007. A total of 503 patients had severe pelvic endometriosis; of these, 115 patients underwent LH and 388 patients underwent AH. Surgical outcomes-including operative time, blood loss, length of hospital stay, and need for blood transfusion-were analyzed and compared between the 2 treatment groups. RESULTS: Operative time was significantly longer for LH than for AH (185.1 ± 48.7 minutes and 139.9 ± 52.4 minutes, respectively; P<0.001). However, estimated volume of blood loss, length of hospital stay, and complication rates were significantly less for patients in the LH group than for those in the AH group (302.6 ± 255.1 mL versus 760.9 ± 633.2 mL [P<0.001]; 3.5 ± 1.1 days versus 6.4 ± 3.0 days [P<0.001]; and 18.3% versus 49.0% [P<0.001], respectively). CONCLUSION: Compared with AH, LH was associated with fewer complications. LH should, therefore, be the preferred surgical option for women with severe pelvic endometriosis who require a hysterectomy.
Subject(s)
Endometriosis/surgery , Hysterectomy/methods , Laparoscopy/methods , Adult , Blood Loss, Surgical , Endometriosis/pathology , Female , Humans , Hysterectomy/adverse effects , Length of Stay , Middle Aged , Retrospective Studies , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
AIMS: To analyse and describe cases of unexpected ovarian malignancy after conservative laparoscopic surgery for an apparent benign ovarian mass at our centre. METHODS: This retrospective study was performed by collecting data from records of premenopausal women who underwent conservative laparoscopic surgery for benign ovarian mass at Siriraj Hospital over a 5 year period from 2006 to 2010. The rate of unexpected malignancy, histopathological type of the ovarian neoplasm and follow-up after surgery were reviewed. RESULTS: During the study period, 1,161 patients underwent conservative laparoscopic surgery. Of these, five (0.43%) had ovarian malignancy which were diagnosed after reviewing histopathological report postoperatively. The histopathological diagnosis was borderline tumour in two patients, clear cell carcinoma, granulosa cell tumour and mucinous cell adenocarcinoma in the other three patients. All patients are alive after a mean follow-up of 9-60 months with two patients developed recurrence. CONCLUSION: The main concern for laparoscopic management of ovarian masses is unexpected malignancy. However, with careful patient selection, proper technique and an experienced operator, laparoscopic treatment of ovarian masses is the best approach and should be implemented, with low risk of unexpected malignancy and recurrence.