ABSTRACT

It has been aimed to compare after veres closed trocar and open entry techniques in laparoscopic surgery performed for benign gynecological pathologies, in terms of peri-operative characteristics, complications, postoperative pain scales and analgesic requirements.

Two hundred and thirteen patients who applied to the gynecology outpatient clinics of Sirnak Idil State Hospital and Universal Malatya Hospital were included in the prospective study. After entry into the peritoneal cavity, after veres closed trocar technique was used for 152 of these patients (Group 1), open entry technique was used for 61 of these patients (Group 2). The duration until the operation, total operating time, perioperative and postoperative complications were recorded. At the end of the postoperative 6^th and 24^th hours, the pain status of the patients was scored by applying VAS, and analgesic requirement was evaluated

In both groups, there was no difference in terms of baseline assessments such as age, BMI, parity. Total operating time was similar in both groups (p=0.085). The duration passing until the operation was longer in Group 1 than in Group 2 (p=0.036). In terms of perioperative complications, the failure in first entry into the peritoneal cavity (p=0.023) and preperitoneal insufflation (p=0.028) were higher in Group 1 than Group 2. Gas leak that disrupts the comfort of surgery was found higher in Group 2 (p=0.016). Decrease in hemoglobin was found lower in Group 1 than Group 2 (p=0.048). There was no difference seen in the comparasion of both two techniques in terms of minor hematoma, wound infection, urologic injury and paralytic ileus. When VAS scores were checked after the operation at the 6^th and 24^th hours (3.1-3.4; 2.1-2.5) and analgesic requirements were compared, there was no difference between Group 1 and Group 2 (p=1.27).

The failure of a single entry, preperitoneal insufflation, andintestinal damage were seen higher in after Veres trocar entry than open entry. Operating times were similar, but the duration passing until the operation was found shorter for open entry. There was no significant difference in terms of minor hematoma, paralytic ileus, wound infection and urologic injury for both techniques. Decrease in hemoglobin was observed greater in open entry technique. There was no significant difference between the two groups in terms of VAS scores evaluated at the end of the postoperative 6^th and 24^th hours and analgesic requirement provided by ketoprofen. As a result, there were advantages and disadvantages of both techniques. There is no absolute superiority of either techniques. According to the experience and habit of the surgeon, both can be preferred. (JAREM 2012; 2: 104-8)