Hysterectomy for Benign Indications in Obese Women: Laparoscopic or Abdominal Approach?

Abstract

Aim: This study aimed to evaluate surgical outcomes associated with laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) in obese women. Material and Methods: A retrospective review was conducted of obese women (body mass index, BMI, >30 kg/m2) who underwent hysterectomy for benign indications between 2018 and 2022. Patients were divided into two groups based on surgical approach, LH and AH. Demographic characteristics, operative time, hospitalization day, and perioperative complications were compared. Results: A total of 425 patients were included, comprising 146 (34.4%) AH and 279 (65.6%) LH cases. The groups were comparable in mean age (49.0±6.4 vs. 47.8±5.7 years, p=0.057), though BMI was significantly higher in the LH group (33.4±3.7 vs. 32.4±2.9 kg/m2, p<0.001). The LH group demonstrated significantly shorter mean operative time (104.0±20.6 vs. 117.0±17.6 minutes, p<0.001) and also reduced median hospitalization day (2, range: 1-15, vs. 3, range: 2-14 days, p<0.001). The rate of intraoperative complications was comparable in both groups (n=5, 3.4% vs. n=2, 0.7%, p=0.050). However, a significantly higher postoperative complication rate was observed in the AH group (n=12, 8.2% vs. n=9, 3.2%, p=0.024). Conclusion: LH in obese women was associated with shorter operative time, reduced hospitalization days, and lower rates of postoperative complications compared with AH. The overall findings suggest that LH is a safe and effective alternative to AH in obese patients. Further prospective studies are required to confirm these retrospective results and control for heterogeneity.

Keywords

• Body mass index
• hysterectomy
• laparoscopy
• obesity
• surgical outcomes

Obez Kadınlarda Bening Endikasyonlu Histerektomi: Laparoskopik mi, Abdominal mı?

Abstract

Amaç: Bu çalışmanın amacı, obez kadınlarda laparoskopik histerektomi (LH) ve abdominal histerektomi (AH) ile ilişkili cerrahi sonuçları değerlendirmektir. Gereç ve Yöntemler: 2018 ve 2022 yılları arasında iyi huylu endikasyonlarla histerektomi geçiren obez kadınlar (vücut kitle indeksi, VKİ, >30 kg/m2) geriye dönük olarak incelendi. Hastalar cerrahi yaklaşıma göre, LH ve AH olarak iki gruba ayrıldı. Demografik özellikler, operasyon süresi, hastanede kalış süresi ve perioperatif komplikasyonlar karşılaştırıldı. Bulgular: Çalışmaya 146 (%34,4) AH ve 279 (%65,6) LH olgusu olmak üzere toplam 425 hasta dahil edildi. Gruplar ortalama yaş açısından benzerdi (49,0±6,4 ve 47,8±5,7 yıl, p=0,057), ancak VKİ, LH grubunda anlamlı derecede daha yüksekti (33,4±3,7 ve 32,4±2,9 kg/m2, p<0,001). LH grubu anlamlı derecede daha kısa ortalama ameliyat süresi (104,0±20,6 ve 117,0±17,6 dakika, p<0,001) ve daha kısa ortanca hastanede kalış süresi (2, aralık: 1-15 ve 3, aralık: 2-14 gün, p<0,001) gösterdi. İntraoperatif komplikasyon oranı her iki grupta da benzerdi (n=5, %3,4 ve n=2, %0,7, p=0,050). Ancak AH grubunda anlamlı derecede daha yüksek bir postoperatif komplikasyon oranı gözlendi (n=12, %8,2 ve n=9, %3,2, p=0,024). Sonuç: Obez kadınlarda LH, AH'ye kıyasla daha kısa ameliyat süresi, daha kısa hastanede kalış süresi ve daha düşük postoperatif komplikasyon oranları ile ilişkilendirilmiştir. Genel bulgular, LH'nin obez hastalarda AH'ye güvenli ve etkili bir alternatif olduğunu göstermektedir. Bu retrospektif sonuçları doğrulamak ve heterojenliği kontrol etmek için daha fazla prospektif çalışmalara ihtiyaç vardır.

Keywords

• Vücut kitle indeksi
• histerektomi
• laparoskopi
• obezite
• cerrahi sonuçlar

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