•Vaginal hysterectomy in local anaesthesia and sedation in feasible.•In our study it was associated with lower pain scores the first two days after the procedure.•It can be especially beneficial for ...older patients with serious medical comorbidities.
Vaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA.
In this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05.
Seventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group.
Our results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.
Pri več kot 85 % žensk med vaginalnim porodom pride do določene stopnje poškodbe presredka, pri čemer se obporodne poškodbe analnega sfinktra pojavljajo v povprečju pri 0,5–7 % vseh vaginalnih ...porodov. Kar 20–40 % primerov obporodnih poškodb analnega sfinktra je prikritih ali spregledanih, zato jih je izjemno pomembno prepoznati. Če odkrijemo poškodbo analnega sfinktra, jo je treba oskrbeti v operacijski dvorani. Pred kirurško oskrbo moramo zagotoviti ustrezno osvetlitev in analgezijo ter rano natančno pregledati. Anorektalno sluznico zašijemo s posameznimi ali kontinuiranimi šivi, notranji analni sfinkter pa s posameznimi ali t. i. šivi mattress. Pri poškodbah zunanjega analnega sfinktra, ki zajemajo celotno dolžino in debelino mišice, lahko uporabimo bodisi tehniko šivanja konec s koncem bodisi tehniko prekrivanja, pri delnih poškodbah pa tehniko konec s koncem. Na koncu zašijemo še mišice in kožo presredka. Perioperativno je treba uporabiti antibiotično zaščito in odvajala. Po obporodni poškodbi analnega sfinktra je potrebno bolnico spremljati. Prvi pregled naj bo 6 do 12 tednov po porodu. Najpogostejše posledice poškodb analnega sfinktra so bolečina v presredku, bolečine ob spolnih odnosih in druge težave v spolnosti ter analna inkontinenca, ki se pojavi v 15–61 % primerov. Potrebno je opraviti svetovanje glede načina poroda v naslednji nosečnosti, saj se ponovna poškodba analnega sfinktra pojavi v 4–8 %.
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