Surgical outcome and midterm follow-up after transvaginal NOTES hybrid cholecystectomy: analysis of a prospective clinical series.

BACKGROUND

In the last 3 years transvaginal hybrid cholecystectomy (TV-ChE) has gained widespread interest as a potential alternative to laparoscopic cholecystectomy. However, substantial doubts about the transvaginal access and possibly associated complaints and complications have been raised.

MATERIALS AND

METHODS

This was a prospective clinical series of 80 consecutive female patients, nonrandomly chosen and without a control group, who underwent a TV-ChE. All patients were evaluated with special regard to outcome data such as surgical complications and gynecological complaints. Perioperative clinical data were collected and a gynecological examination was performed 3 weeks after surgery as well as a follow-up survey 3 months after surgery.

RESULTS

The TV-ChE was performed in all patients without conversion to laparoscopy or open surgery. Two surgical complications occurred (1 urinary bladder injury and 1 case of bleeding). No infections of the surgical wound or any other complications were seen in the gynecological follow-up examination 3 weeks after the operation. After a follow-up of 3 months, 4% of the patients under 50 years of age reported slight and temporary problems after transvaginal cholecystectomy (dyspareunia and episodes of unclear lower abdominal pain), whereas such phenomena were seen in about 9% of women over 50 years of age (P < .05). A 33-year-old woman became pregnant 3 weeks after the operation.

CONCLUSIONS

TV-ChE is a safe and less invasive surgical technique. Doubts about this operating technique with regard to an increased risk of infection or surgical complications as well as subsequent gynecological problems seem to be unfounded.