Laparoscopic simultaneous operations in women

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Introduction. During the last years the method of simultaneous surgery, i.e. simultaneous operations using laparoscopic approach, has been elected in increasing frequency for combined surgical internal diseases. The efficacy of these interventions is controversial. The lack of data about the influence of simultaneous operations on the quality of life in women suffering from gynecological and surgical pathology defined the relevance and objectives of this study.

Material and methods. 56 patients with different gynecological and surgical pathology made group I and 24 patients with genitals diseases made group II. In performing the basic stage of simultaneous operation in group I, the following findings were considered as an indication for this type of treatment: hysteromyoma (42,2%), cystic adenoma (20,4%), and uterine tubes lesion (26,8%); in performing the associated stage they were: cholecystitis (28,9%), chronic and acute appendicitis (8,9%), omphalocele and bubonocele (5,6%). In group II, the one-stage operation was performed for hysteromyoma (58,8%), ovaritis and salpingitis (41,2%). Laparoscopic approach was used in all cases. The outcomes were evaluated basing on clinical and laboratory data, as well as the quality of life in a week, one, six, and twelve months after operation, according to the inquirer “Quality of Life in Women” (NTSAG and P RAMN). Results. Prior to simultaneous operation, the quality of life in women was characterized by low physical activity (86,3%), regardless of a type of combined pathology. 96,4% patients complain of depression, alarm, nervousness, and emotional instability. Changes in the role functions become apparent in the problems arising in the occupational activities (66,4%), the necessity to reduce working hours (58,4%). 67,8% patients demonstrated the changes in sexual activities, seen as the decrease in sexual contact rate in (53,6%) due to sexual dissatisfaction (72,6%). The quality of life in women with combined pathology depends on the character of sexual damage, the degree and length of disease. Associated surgical diseases deteriorate the quality of life in patients to integral performance criterion of 3,88 ± 1,07 points. The quality of life in patients prior to one-stage gynecological operation is less impaired as to all the parameters, the integral performance criterion making up 2,84 ± 0,87 points. The data of investigations show that patients’ quality of life after simultaneous operations depends on the type and scope of both basic and associated stage of operation. Results. Thus, organ-preserving operations (myomectomy, ovariotomy) improve the quality of life. Radical operations (hysterectomy, ovariectomy) can significantly upset the state of welfare, self-certification of health, and impair the quality of life. The comparative analysis of life quality factors after simultaneous and one-stage operations demonstrated that with initial lower parameters of the quality of life in patients with combined gynecological and surgical pathology, simultaneous surgery renders a more positive effect on the dynamics of the quality of life components after operation, showing a reliable improving of psychoemotional, social role functions, self-certification of health and quality of life in patients.

About the authors

N. B. Singaevsky

Multi-Profile Clinic n. a. N.I. Pirogov

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Saint Petersburg

А. V. Borisov

Multi-Profile Clinic n. a. N.I. Pirogov

Email: info@eco-vector.com
Russian Federation, Saint Petersburg

N. V. Bokuchava

Multi-Profile Clinic n. a. N.I. Pirogov

Email: info@eco-vector.com
Russian Federation, Saint Petersburg

V. K. Jaroslavsky

Multi-Profile Clinic n. a. N.I. Pirogov

Email: info@eco-vector.com
Russian Federation, Saint Petersburg

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