Total Laparoscopic Hysterectomy in Obese and Morbidly Obese Women

Abstract

Background: The study aimed at estimating the effect of body mass index (BMI), used to classify non-obese, obese, and morbidly obese patients, on clinical outcomes in total laparoscopic hysterectomy (TLH) cases. Methods: This retrospective cohort study included 153 patients who underwent TLH for benign, premalignant, or malignant conditions between August 2010 and June 2013. Patients were divided into 3 groups according to BMI, and the following variables were analyzed: operation time, conversion rate, blood loss, total complications, and length of hospital stay. Results: The mean BMI was 33.5 kg/m² (range, 22-61). Forty-four patients were non-obese (BMI <30), 73 were obese (30≤ BMI <40), and 36 were morbidly obese (BMI ≥40). In 138 patients (90.2%), hysterectomy was performed using an endoscopic technique. The rate of conversion to laparotomy (9.8%; 95% confidence interval (CI), 5.1-14.5), blood loss (70.5 ml; range, 10-700), total complications (5.9%), and length of hospital stay (2.9 d; range, 1-8) did not vary according to BMI. Operation time was longer in obese (p = 0.003) and morbidly obese (0.002) patients than in non-obese patients. Conclusion: TLH could be considered a safe and feasible alternative to abdominal hysterectomy in obese and morbidly obese patients.

A Comparative Study of the Influence of Body Mass Index on Clinical Outcomes of Total Laparoscopic Hysterectomy in Birat Medical College Teaching Hospital, Morang, Nepal

“…Similarly, average days of postopera ve hospital stay in obese pa ents a er 15 TLH was one day , ranging from 1-5 days. In another study by Otake A et al (2019), mean postopera ve hospital stay was 5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) days in normal BMI group, 5 (4-10) days in 3 overweight group and 5 (4-37 ) days in obese group. In our study, mean postopera ve hospital stay was 3.46±0.68 days (range: 3-6 days) in high BMI group and 3.05±0.47 days (range:3-4days), the difference was sta s cally not significant (p=0-74 Chopin N et al (2009) analyzed 1460 women who underwent TLH among which 1021(69.9%) had normal BMI, 338 (23.2%) were overweight pa ents and 101 (6.9%) were obese (BMI >30).…”

“…The difference was sta s cally not significant (p0.185). Guraslan H et al(2015) reported the mean opera on me significantly higher in obese (128 ± 32 min) and morbidly obese pa ents (130 ± 21 min) than in non-obese (110 ± 23 min) pa ents. The most important reason for this difference is the restricted movement of the laparoscopic instruments Similarly, in the study by Bardens D et al, mean opera ve me was 129.0±58.6 minutes in normal weight group (n=90), 135.4±46.9 minutes in overweight group (n=47) and 154±64.2 minutes in obese women with BMI >30 (n=52).…”

“…These problems may be overcome by skilled surgeons, anesthe sts, and medical staff in the 3 opera ng room. Laparoscopic hysterectomies are feasible, safe, and provide shorter hospital stays and less blood loss in 5,13,14 the obese pa ent popula on.…”

Factors related to blood loss in laparoscopic hysterectomy

“…Güraslan et al [7] found no difference in hemoglobin changes in patients with normal BMI, obese, and morbidly obese patients undergoing a total laparoscopic hysterectomy 1.11 ± 1.5 g/dL, 1.15 ± 1.7 g/dL, 1.11 ± 1.8 g/dL (p = 0.427), respectively. They recommended TLH as a safe and viable alternative to abdominal hysterectomy in obese and morbidly obese patients.…”

Benign endikasyonlarda laparoskopik ve abdominal histerektomi

“…Bizim çalışmamızda uzun operasyon süresi ve yüksek laparotomiye dönme oranlarının nede-ni TLH grubundaki hastaların ortalama vücut kitle indeksinin obezite sınırının üstünde olması olabilir (Ortalama VKİ 32 ± 6). Daha önce içinde bizim çalışmamızında bulunduğu bir çok çalışmada obezitenin uzun operasyon süresi ve artmış laparotomiye dönme oranlarıyla ilişkili olduğu rapor edilmiştir [20,22,23]. Laparoskopik yaklaşımın en önemli avantajlarından bir tanesi abdominal yaklaşıma göre hızlı iyileşme ve artmış yaşam kalitesidir.…”