[Uterine myomatosis--abdominal hysterectomy, vaginal hysterectomy or laparoscopic-assisted vaginal hysterectomy?].
OBJECTIVE
To evaluate the way of the surgical treatment of uterine fibroids in two 5 year long periods. In the first period (1987-1991) the operative procedures--hysterectomies--were performed usually by the classical abdominal approach. In the second period (1997-2001) the modern trend of minimal invasive surgery was applied. Through analysis of three surgical procedures used (AHY, VHY, LAVHY) the conclusions concerning the advantages, disadvantages and correct indications for the selection of hysterectomy in cases of uterine fibroids are presented.


METHODS
Retrospective study.


METHODS
Department of Obstetrics and Gynecology, Medical Faculty and University Hospital, Palacký University, Olomouc.


METHODS
The total of 1172 patients (604 in the first period and 568 in the second period) were operated by abdominal hysterectomy (AHY), vaginal hysterectomy (VHY) or laparoscopically assisted vaginal hysterectomy (LAVHY). The factors influencing the mode of hysterectomy (body mass, weight of uterus, parity, adnexal finding, previous surgery) were analyzed. The type of anesthesia and per and postoperation complications (blood loss, conversion of vaginal to abdominal approach, inflammatory complications and administration of antibiotics) were also evaluated.


RESULTS
Each of the chosen surgical procedures has advantages and disadvantages. Abdominal hysterectomy as the most invasive procedure is indicated only in extremely unfavourable findings. The least invasive procedure is VHY, which therefore is the optimal solution for the patient. LAVHY represents the operation which combines advantages of both AHY and VHY and fulfills also the criteria for minimal invasive surgery.


CONCLUSIONS
The choice of the optimal surgical procedure in patients with uterine fibroids depends on the complex assessment of the preoperative finding, the technical possibilities of the setting and the experience of the surgeon. The goal is to chose the safest but at the same time least invasive surgical procedure.
Kudela
M
M
Klinika porodnictví a gynekologie LF UP v Olomouci.
Zahradnícková
V
V
Hejtmánek
P
P
D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D018231:Leiomyomatosis / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*