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Vaginale und abdominale Hysterektomie

Vaginal and abdominal hysterectomy

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Hysterektomie ist einer der am häufigsten durchgeführten gynäkologischen Eingriffe. Ist die Indikation zur Gebärmutterentfernung gestellt, so gibt es zwar verschiedene Operationstechniken, zwischen denen der Operateur entscheiden kann, jedoch zwei hauptsächliche Zugangswege – abdominal oder vaginal. Zu berücksichtigen sind dabei die Vor- und Nachteile des jeweiligen Operationsverfahrens, die Größe und Mobilität des Uterus, vorausgegangene Operationen der Patientin, die Erfahrung des Operateurs sowie die lokalen Operationsbedingungen. Im Vergleich beider Zugangswege bietet der vaginale Zugang deutliche Vorteile gegenüber dem abdominalen Vorgehen: Verkürzung der Operationszeit und Reduktion der postoperativen Schmerzen. Daher sollte er zur primären Hysterektomie bei benignen Erkrankungen bevorzugt werden. Bei Uterus myomatosus und dysfunktionellen uterinen Blutungen ist die vaginale Hysterektomie der abdominalen vorzuziehen. Die Integration von neuen technischen Möglichkeiten, wie den bipolaren Koagulationszangen, hat in den letzten Jahren die hämostatischen Möglichkeiten verbessert und zu einem geringeren Blutverlust und reduzierten postoperativen Wundschmerzen geführt.

Abstract

Hysterectomy is one of the most common major gynecological operations. There are several different techniques for performing it, and if it is indicated, the appropriate operative approach, vaginal or abdominal, must be chosen. The advantages and disadvantages of the two approaches, the uterine size and mobility, previous operations, the surgeon’s experience, and the local operating conditions should all be considered. Vaginal hysterectomy has advantages compared with abdominal hysterectomy: The operating time is shorter, it is safer, and the hospital stay and recovery time are shorter as well. Therefore, a vaginal approach should be preferred in patients with benign diseases. Vaginal uterine extirpation is the first operative choice in patients with uterus myomatosus and dysfunctional uterine bleeding. The integration of new technical possibilities, such as bipolar coagulation forceps, has improved haemostasis and produces less blood loss and less postoperative pain.

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Thill, A. Hornemann, D. Fischer, K. Diedrich & C. Altgassen

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  1. M. Thill
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  2. A. Hornemann
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  3. D. Fischer
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  4. K. Diedrich
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  5. C. Altgassen
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Correspondence to M. Thill.

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Thill, M., Hornemann, A., Fischer, D. et al. Vaginale und abdominale Hysterektomie. Gynäkologe 41, 328–336 (2008). https://doi.org/10.1007/s00129-008-2130-z

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