Comparison of laparoscopic, vaginal and abdominal hysterectomy outcomes in obese patients: A retrospective analysis

Year 2025, Volume: 3 Issue: 1, 7 - 12, 01.02.2025

Özge Nur Gülen , Ayşe Özdemir , Emre Yalçin

https://doi.org/10.61845/agrimedical.1532325

Abstract

Aim: Obesity is a chronic condition that is increasingly prevalent globally and poses significant risks in the context of surgical procedures. Hysterectomy is among the most commonly performed surgeries in the field of gynecology. However, there is a paucity of studies in the existing literature that compare the various hysterectomy techniques in obese women. Consequently, this study aimed to elucidate the advantages and disadvantages of abdominal, laparoscopic, and vaginal hysterectomies performed on obese patients at our institution.
Material and Method: This study is a retrospective cohort analysis involving 100 patients with a body mass index exceeding 30 kg/m² who underwent hysterectomy for benign indications at the Ondokuz Mayıs University Faculty of Medicine, Department of Gynecology, between 2016 and 2020. Among these patients, 40 underwent abdominal hysterectomy, 42 underwent laparoscopic hysterectomy, and 18 underwent vaginal hysterectomy. The intraoperative and postoperative outcomes of the 100 patients who underwent hysterectomy using these three different surgical techniques were compared.
Results: Laparoscopy emerged as the surgical method associated with the lowest risk of postoperative wound infection and minimal blood loss. However, it is important to note that laparoscopic hysterectomy incurs higher costs and requires a longer operative time compared to other surgical approaches. Conversely, vaginal hysterectomy is characterized by the shortest hospital stay, the least requirement for postoperative intensive care, and the lowest overall cost. Notably, the highest blood loss was observed in patients who underwent vaginal hysterectomy. In terms of operative duration, abdominal hysterectomy was identified as the most efficient approach.
Conclusion: For obese patients, less invasive hysterectomy techniques, vaginal and laparoscopic methods, may enhance postoperative outcomes.

Keywords

Abdominal hysterectomy, Vaginal hysterectomy, Laparoscopic hysterectomy, Obesity

Obez hastalarda laparoskopik, vajinal ve abdominal histerektomi sonuçlarının karşılaştırılması: Retrospektif bir analiz

Abstract

Amaç: Obezite dünyada prevalansı artmakta olan kronik bir hastalıktır ve cerrahi açıdan bir risk faktörüdür. Histerektomi jinekolojik cerrahide sık uygulanan operasyonlardan biridir. Literatürde histerektomi yöntemlerinin obez kadınlar üzerinde karşılaştırılması hakkında çok sayıda çalışma mevcut değildir ve bu nedenle merkezimizde obez hastalara yapılan abdominal, laparoskopik ve vajinal histerektomilerin avantajları ve dezavantajlarının ortaya çıkarılması hedeflenmiştir.
Gereç ve Yöntem: Çalışmamız bir retrospektif kohort çalışması olup çalışmada 2016-2020 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Kadın Hastalıkları Anabilim Dalında benign sebeplerle histerektomi yapılan vücut kitle indeksi 30kg/m2’nin üzerinde olan 100 hasta incelenmiştir. Bu hastaların 40’ı abdominal histerektomi, 42’si laparoskopik histerektomi, 18’i vajinal histerektomi operasyonu geçirmiştir. Üç farklı yöntemle histerektomi operasyonu yapılan 100 hastanın intraoperatif ve postoperatif sonuçları karşılaştırılmıştır.
Bulgular: Çalışmamızda postoperatif yara yeri enfeksiyonu gelişim riski en düşük, kan kaybı en az olan yöntem laparoskopidir. Ancak laparoskopik histerektomi daha maliyetli ve operasyon süresi diğer gruplara göre daha uzundur. Hastanede yatış süresi en kısa, postoperatif yoğun bakım ünitesi gereksinimi en az olan ve en düşük maliyetli operasyon vajinal histerektomidir. En fazla kan kaybının vajinal histerektomi hastalarında olduğu görülmüştür. Operasyon süresi açısından en avantajlı grup abdominal histerektomidir.
Sonuç: Obez hastalarda histerektomi yöntemi seçerken daha az invaziv yöntemler olan vajinal ve laparoskopik yöntemlerin seçilmesinin postoperatif sonuçları iyileştireceğini düşünmekteyiz.

Keywords

Abdominal histerektomi, Vajinal histerektomi, Laparoskopik histerektomi, Obezite

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