Follow Up of Women after Laparoscopy Versus Laparotomy in Emergency Gynecological Problems

Abstract

Background:  Lifesaving is  not  the  only  aim  of  surgery  for  acute  abdomen  but preservation  of  infertility  is  the  main  goal  of  each  gynecological  or  pelvic  surgery  in reproductive age female. Infertility may results from these surgeries because of adhesions, tubal damage or blockage and its effects on ovarian reserve. The benefits of laparoscopy in the last years were recognized because of short recovery and hospital stay with minimal scars . Follow up studies of laparoscopy or  laparotomy were for short period or few months. So the aims of this study are to recognize the differences between laparotomy and laparoscopy and their effect on ovarian reserve and infertility and to clarify the benefit of laparoscopy versus ultrasound in diagnosis of acute abdomen due to gynecological problems.
Patients and Methods: A longitudinal prospective study was done at teaching center and  approved by scientific committee of the college of medicine. Two hundred seventeen patients had acute abdomen during study period and only (98) patients were excluded from the study according to its exclusion criteria . The remaining  (119) patients were enrolled in the study. (57) patients were enrolled in laparoscopic group or group (1) and (62) patients in laparotomy group or group (2). Full history, general, abdominal ,pelvic examinations and basic investigations were done to all patients. Vaginal and abdominal ultrasound (2D) examinations were done to each patient before operation and after 1,3 months and 1 year during the period of follow up. Chest x- ray, abdominal x-ray ,MRI and CT scan were done to the patients on need. After stabilization of patient, surgery was done to her. Follow up of patients was for to 5 years to monitor below main outcomes measures.
Main  outcomes  measures: Operation  time,  recovery  period,  usage  of  injectable analgesia, drop in hemoglobin level, W.B.C count changes, antral follicles count (AFC) changes and ovarian volume changes.
Results: different pathological problems were found in relation to gynecological acute abdomen  in  reproductive  age  women,  such  as  different  ovarian  cyst  ,ectopic  pregnancy, appendicitis, intestinal obstruction and acute cholecystitis. No significant changes were found in parameters of ovarian reserve in both surgeries.
Conclusions:  multiple  pathologies  can  cause  acute  abdomen  due  to  gynecological problems  in  relation  to pelvis at  reproductive  age  and  different  factors  would  affect  the outcomes of laparoscopy and laparotomy groups .