Carolin Spüntrup1,2,3, M Banerjee4,5, J Piana6, M Hellmich7, J Bojahr8, B Bojahr8, C Albus9, G Noé6,5. 1. Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany. carolin.banerjee@gmx.de. 2. Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany. carolin.banerjee@gmx.de. 3. Pelvic School Saarbrücken, Hohe Wacht 77, Saarbrücken, Germany. carolin.banerjee@gmx.de. 4. Department of Orthopedic Surgery and Sports Traumatology, Atos Media Park Clinic, Cologne, Germany. 5. University of Witten/Herdecke, Witten, Germany. 6. Department of Obstetrics and Gynecology, Rheinlandklinikum Dormagen, Dormagen, Germany. 7. Institute for Medical Statistics and Epidemiology, University of Cologne, Cologne, Germany. 8. MIC Clinics, Berlin, Germany. 9. Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany.
Abstract
PURPOSE: Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. METHODS: 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. RESULTS: 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. CONCLUSION: Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.
PURPOSE: Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet. METHODS: 311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups. RESULTS: 11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method. CONCLUSION: Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.
Authors: Deslyn T G Hobson; Anthony N Imudia; Zain A Al-Safi; George Shade; Michael Kruger; Michael P Diamond; Awoniyi O Awonuga Journal: Arch Gynecol Obstet Date: 2011-11-29 Impact factor: 2.344