Total Laparoscopic Hysterectomy in Obese Versus Nonobese Patients

Obstet Gynecol. 2004 Apr;103(4):674-80. doi: 10.1097/01.AOG.0000119224.68677.72.

Abstract

Objective: To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients.

Methods: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m(2) or greater with those whose BMI was less than 30 kg/m(2).

Results: Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m(2) or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups.

Conclusion: Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients.

Level of evidence: II-2

MeSH terms

  • Adult
  • Body Mass Index
  • Cohort Studies
  • Female
  • Humans
  • Hysterectomy / adverse effects*
  • Intraoperative Complications
  • Laparoscopy / adverse effects*
  • Obesity / surgery*
  • Postoperative Complications
  • Retrospective Studies
  • Risk Assessment
  • Treatment Outcome