Ağır Endometriozisli Hastada Zor Laparoskopik Histerektomi
Özet
Endometriozisin cerrahi tedavisinde implantın derinliği önemli rol oynamaktadır ve cerrahide laparoskopinin daha yaygın olarak kullanılmasının invaziv endometrial implantların daha iyi ablasyonu ve adhezyoliziste daha başarılı olduğu açıktır. Cerrahın tecrübesi arttıkça cerrahinin başarısı artmakta üreter ve sinir hasarının da önüne geçilebilmektedir. DİE (derin infiltratif endometriozis)’li bir hasta için histerektomi planlandığında, cerrahi adımlar, özellikle semptomatik hastada, radikal kombine çözüm sağlayacak şekilde uyarlanmalıdır. Histerektomi sırasında lezyonların radikal eksizyonunu amaçlayan konservatif DIE cerrahisi prensiplerine uyulmalı ve saygı gösterilmelidir. Yapılan çalışmalar neticesinde DİE vakalarında her ne kadar uzamış vaka süresi ve zorlu adhezyolizis ve diseksiyonlara rağmen TLH sonrası komplikasyonların toplam riski kabul edilebilir görünmektedir.
The depth of the implant plays an important role in the surgical treatment of endometriosis and it is clear that the more common use of laparoscopy in surgery is more successful in better ablation and adhesiolysis of invasive endometrial implants. As the experience of the surgeon increases, the success of the surgery increases and ureter and nerve damage can be prevented. When hysterectomy is planned for a patient with DIE (deep infiltrative endometriosis), the surgical steps should be adapted to provide a radical combined solution, especially in the symptomatic patient. During hysterectomy, the principles of conservative DIE surgery aiming at radical excision of lesions should be followed and respected. The overall risk of complications after TLH in DIE cases seems to be acceptable, despite the prolonged case duration and difficult adhesiolysis and dissections.
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