Abstractthe retrospective analysis of operative hysteroscopy cases performed in our clinic between 2018-2023

The retrospective analysis of operative hysteroscopy cases performed in our clinic between 2018-2023 was conducted. It was observed that some patients undergoing operative hysteroscopy received only this procedure, while others underwent additional diagnostic laparoscopy. Although subject to the surgeon's preference in daily practice, consensus on indications for solely operative hysteroscopy versus those requiring diagnostic laparoscopy alongside it could be reached. Thus, we undertook this study to compare these groups in terms of hospital stay and hematological parameters. Over a 5-year period, 401 patients underwent operative hysteroscopy in our clinic, with 15 excluded due to incomplete data, resulting in a total of 386 patients included in the study. Demographic data, pre- and post-operative hemogram values, intraoperative complications, length of hospital stay, performance of diagnostic laparoscopy, and insertion of Mirena were examined. The youngest patient included was 18 years old, while the oldest was 74, with a mean age of 38.48 ± 10.66 years. The longest hospital stay was 4 days, with an average of 1 ± 0.5 days. The mean preoperative HGB value was 12,89±1,47, and the postoperative HGB value was also 11.91 ± 1.40. All 386 patients included underwent operative hysteroscopy, with 155 (40.2%) undergoing simultaneous diagnostic laparoscopy. In 70 cases (18.1%), intraoperative Mirena insertion was performed to prevent endometrial adhesions. Non-lethal complications were observed in only 1 patient (0.3%). It was noted that diagnostic laparoscopy was preferred in addition to operative hysteroscopy for patients undergoing uterine septum surgery, where the risk of rupture is high, while cases with a low complication probability, such as endometrial polyps, underwent solely operative hysteroscopy. Additionally, comparing the group undergoing diagnostic laparoscopy with the group undergoing only operative hysteroscopy in our study revealed a shorter hospital stay and a lesser decrease in postoperative hemogram levels in the latter group. In cases with a high risk of complications, such as uterine septum surgery, endometrial adhesion, istmosel where the risk of rupture is high, diagnostic laparoscopy should be performed in addition to operative hysteroscopy to observe the intra-abdominal environment. We believe that operative hysteroscopy is a comfortable procedure for patients. However, further prospective randomized controlled studies involving more patients are needed to determine which group should undergo solely operative hysteroscopy and which group requires diagnostic laparoscopy in addition. Keywords: Operative hysteroscopy, Laparoscopy, Septum, Endometrial polyp