Comparative aspects of surgical treatment of patients with benign ovarian tumors who underwent hysterectomy

Abstract

DOI: 10.52705/2788-6190-2026-02-5
УДК 618.11-006.03-089:18.14-089.87

The objective: to study the comparative aspects of surgical treatment of patients with benign ovarian tumors after hysterectomy.
Materials and methods. A retrospective analysis of case histories and video recordings of operations of 83 patients operated on for benign ovarian tumors was conducted. All patients were admitted to the hospital on a planned basis with the diagnosis: «Benign ovarian neoplasm». 65 out of 83 patients complained of chronic pelvic pain and pain during sexual intercourse. All patients had previously undergone total or subtotal hysterectomy without appendages via laparotomic access due to uterine fibroids, adenomyosis, or recurrent dysfunctional uterine bleeding. Main group 1 – 48 patients were operated on for ovarian tumors via laparoscopic access. The comparison group consisted of 35 patients who underwent laparotomic surgery for ovarian tumors.
The complex of conducted studies included clinical, laboratory, instrumental, and statistical methods.
Results. In the main group of patients, 2 complications (6,25 %) were recorded: bladder injury – 1 (20,8/1000), hemorrhage – 1 (20,8/1000). During the extirpation of the cervical stump, a bladder injury occurred caused by laparoscopic scissors at the dissection stage due to dense adhesions between the bladder and the cervical stump. The length of the defect was approximately 1 cm. The complication was diagnosed intraoperatively by introducing a methylene blue solution into the catheterized bladder. The 0.5 cm bladder defect was sutured with double-row interrupted sutures. Vicryl was used as the suture material. In the postoperative period, continuous bladder catheterization was performed for 5 days. The postoperative period proceeded without complications. The patient was discharged from the hospital on the 7th day. Intraoperative hemorrhage developed during the performance of an adnexectomy using bipolar coagulation. Specifically, the preliminary coagulation was accompanied by deep tissue dissection. The difficulty of achieving hemostasis under the conditions of the developed hemorrhage lay in the small size of the ligament stump and, consequently, the difficulty in grasping the damaged vessel. The complication that arose did not require conversion; the bleeding was stopped via bipolar coagulation, with the blood loss volume amounting to 250 ml. During operations via laparotomic access for ovarian tumors, 5 complications (14.3 %) were registered: in 3 cases (85,7/1000), an injury to the small intestine occurred during the separation of adhesions, 1 – bladder injury, and 1 – intraoperative hemorrhage from the infundibulopelvic ligament during the mobilization of the ovarian tumor. A study of the catamnesis of these patients showed that no recurrence of the disease was detected during the follow-up period of 3 months to 3 years after the operation.
Conclusions. The results of the comparative analysis of different surgical treatment methods for benign ovarian neoplasms following hysterectomy demonstrate that laparoscopy enables adequate surgical intervention for ovarian neoplasms after hysterectomy to be performed in an anatomically precise and maximally sparing manner. The obtained findings should be utilized in the development of an algorithm for diagnostic and therapeutic-preventive measures.