Guideline No. 386-Gynaecologic Surgery for Patients with Obesity

Yong, Paul J.; Thurston, Jackie; Singh, Sukhbir S.; Allaire, Catherine

doi:10.1016/j.jogc.2018.12.005

Cited by 8 publications

(13 citation statements)

References 61 publications

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“…Similarly, the ERAS suggests that the dose be increased in obese patients (BMI > 35 kg/m 2 or >100 kg) [ 15 ], while the SEIMC and AEC point out the need to use adjusted and ideal body weight, rather than actual body weight, in order to more accurately correct the dose in obese patients [ 14 ]. Finally, even though surgeons can consider using published weight-based dosing of the antibiotic needed, the data to support redosing antibiotics intraoperatively or continuing postoperatively based solely on obesity are insufficient [ 24 ].…”

Section: Resultsmentioning

confidence: 99%

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

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Surgical site infections (SSIs) refer to infections in the incision, organ, or postoperative space. As common healthcare-associated infections, SSIs correlate with prolonged hospital stay, additional procedures, ICU stay, and higher mortality rates. Around 8–10% of gynecologic surgery patients may experience infectious complications, influenced by microbial contamination, surgical nature, and patient factors. The goal of this narrative review is to compare and merge recommendations from globally published guidelines concerning the utilization of antibiotics in the perioperative phase. A comparative descriptive/narrative review of the guidelines issued by the American College of Obstetrics and Gynecology (ACOG), Society of Obstetricians and Gynecologists of Canada (SOGC), Royal College of Obstetricians and Gynecologists (RCOG), National Institute for Health and Care Excellence (NICE), Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), European Society of Gynecologic Oncology (ESGO), Société Française d’ Anésthesie et de Réanimation (SFAR), Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and Hellenic Society of Obstetrics and Gynecology (HSOG) was conducted. For hysterectomy, first/second-generation cephalosporins are suggested, with metronidazole as an option. Laparoscopy without entering the bowel or vagina typically does not require prophylaxis. Uterine evacuation and hysteroscopy may involve doxycycline or azithromycin based on risk factors, whereas, for vulvectomy, cefazolin is recommended. Urogynecology procedures may include cefazolin with metronidazole. In cases of penicillin allergy, cephalosporins are suggested, and, for obese patients, adjusted doses are advised. Additional doses may be needed for prolonged procedures or excessive blood loss. Timing recommendations are 15–60 min before incision, adjusting for specific antibiotics. Clear indications exist for certain surgeries like hysterectomy, termination of pregnancy, and urogynecologic procedures. Conversely, procedures such as intrauterine device insertion, hysteroscopy, and laparoscopy typically do not necessitate antibiotic prophylaxis. For several other procedures, the evidence is inconclusive, while considering dose, timing, and indications can mitigate infectious complications and provide benefits for the healthcare system.

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Section: Resultsmentioning

confidence: 99%

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Petousis,

Angelou,

Almperis

et al. 2024

JPM

View full text Add to dashboard Cite

show abstract

“…We used multivariate linear regression in an effort to limit possible confounders in the evaluation of our primary endpoint. For example, we know that obesity [ 10 ] or previous abdominal surgery are risk factors of difficult entry and higher operative difficulty in general, thus in any case, of prolonged OOT. While in the total study sample, OOT was significantly increased in obese and previous abdominal surgery patients (Fig.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy

Evangelopoulos,

Nessi,

Achtari

2024

J Robotic Surg

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Minimally invasive abdominal sacrocolpopexy (SC) is the treatment of choice for symptomatic, high-grade, apical or multi-compartmental pelvic organ prolapse (POP), in terms of anatomical correction and treatment durability. Robot-assisted sacrocolpopexy (RASC) could be an attractive alternative to the gold standard laparoscopic sacrocolpopexy (LSC), for its ergonomic advantages in such a technically demanding procedure. However, it has not yet proven its superiority, consequently raising cost-effectiveness issues. Our primary objective was to assess if RASC can achieve better overall operative time (OOT) over LSC, with at least equivalent perioperative results. This was a single-center retrospective study including 100 patients (58 consecutive RASC cases and 42 LSC within the same time-period), with primary endpoint the OOT in both groups. Secondary results included complication rate, hospital stay, short-term anatomic results and OOT within and beyond the RASC learning curve. A multivariate linear regression was carried out for our primary outcome. The groups had comparable characteristics, except for BMI, which was lower in RASC group. The mean OOT was significantly lower in the RASC group (188 vs. 217 min, p ≤ 0.01), even after adjusting for possible confounders. Short-term anatomic results, complication rate, and blood loss were similar in the two groups. Mean hospital stay was significantly longer in the RASC group. Average RASC OOT was significantly shorter after the first 20 cases realized. This study demonstrated a significant reduction of OOT for RASC compared to LSC, with similar perioperative results, encouraging further use of the robotic technology for this indication.

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“…NDVH is considered the preferred method for treating benign uterine conditions when the uterus size is up to 12 weeks or up to 280 grams, in general and in obese women, as stated by authoritative organizations such as the ACOG 0n 2015, 2017 and its reaffirm in 2019, 2020 SOGC [28,29] , DHA [30] , ISGE [31] , and the SGS [32] . This preference is based on the costeffectiveness and value-based nature of NDVH compared to TAH and TLH of the Cochrane review of 42 and 62RCTs in 2015 and 2023 [1,33] .…”

Section: Discussionmentioning

confidence: 99%

The Influence of Obesity on Non-Descent Vaginal Hysterectomy (NDVH): A Retrospective Comparison of Obese and Non-Obese Women Undergoing NDVH

2023

The Egyptian Journal of Hospital Medicine

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Background: High body mass index (BMI) ≥ 30 kg/m 2 is associated with non-optimal perioperative consequences in women undergoing hysterectomy and is deemed a contraindication for non-descent vaginal hysterectomy (NDVH) by utmost gynecologic surgeons, is this contraindication authentic or assumed? Objective: To estimate the influence of BMI on perioperative outcomes in patients who underwent NDVH for nonmalignant uterine disorders. Patients and Methods: This retrospective cohort involves 843 patients; 413 patients were non-obese (BMI < 30 kg/m 2 ) and 430 patients were obese (BMI ≥ 30 kg/m 2 ). Results: BMI differed significantly between groups (27.4±6.7 vs. 38.6±11.6, P= 0.0001). Both groups also differed regarding age, parity, preoperative medical comorbidity including hypertension and diabetes mellites, American Society of Anesthesiologists physical status, and endometrial hyperplasia incidence (P<0.05), but were parallel concerning nulliparity, menopausal status, number of prior vaginal birth prior cesarean section, and virgin lower abdomen. No clinically significant alterations were perceived in perioperative consequences as transfusion, ureteral, bladder, or bowel injuries, fever, systemic infections, fistula, conversion to total abdominal hysterectomy, and total postoperative complications. Obese group was associated with significant excess operative blood loos, extended total and actual operative room time, longer postoperative hospital stays, higher rate of deep venous thrombosis (DVT), excess need for general aesthesia, analgesia and venous thromboembolism (VTE) prophylaxis (P<0.05). Conclusions:The outcomes regarding intraoperative conversion to TAH and perioperative consequences disclose that NDVH is safe and feasible for patients with BMI ≥ 30 kg/m 2 and gynecologist shouldn't consider obesity, even morbid or super or more, as a contraindication for NDVH.

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Guideline No. 386-Gynaecologic Surgery for Patients with Obesity

Cited by 8 publications

References 61 publications

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Prophylactic Antibiotics before Gynecologic Surgery: A Comprehensive Review of Guidelines

Minimally invasive sacrocolpopexy: efficiency of robotic assistance compared to standard laparoscopy

The Influence of Obesity on Non-Descent Vaginal Hysterectomy (NDVH): A Retrospective Comparison of Obese and Non-Obese Women Undergoing NDVH

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