TLHにおける腹膜縫合の有用性についての検討

抄録

Purpose: In total laparoscopic hysterectomy (TLH), the risk of postoperative complication of the vaginal stump is reportedly higher than that in total laparotomy. The procedure for TLH has been changed to incorporate a peritoneal suture to the conventional vaginal stump treatment since February 2016. We compared the vaginal stump infection rates before and after the procedure was modified.

Methods: From 2014 to 2017, we conducted 782 TLHs in our department. Among the patients, 430 who had no endometriosis, infectious diseases, and deficient medical records were included in the study. We had been using a single ligation to close vaginal stump and an adhesion inhibitor for peritoneal defects until January 2016 (non-suture group). Since February 2016, the procedure for TLH has been changed to incorporate a peritoneal suture to the conventional vaginal stump treatment (suture group). We analyzed the relationships among the postoperative C-reactive protein (CRP) levels and the rate of vaginal stump infection between the two groups.

Results: Among the 430 patients, peritoneal suture was performed in 247 patients. No significant differences in the CRP levels on post-operative days 1 and 3 were found between two groups. The CRP level after discharge tended to be higher in the non-suture group. Vaginal stump infection occurred 9 (4.9%) of the 183 patients in the non-suture group. And in the suture group, vaginal stump infection occurred 4 (1.6%) of the 247 patients.

Conclusion: Peritoneal suture in TLH can be considered useful for preventing vaginal stump infection after surgery.