SavedAdd your journal

Journals / Düzce Tıp Fakültesi Dergisi / 2025 / Volume: 27 Issue: 3

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

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

Arife Akay(Yalova State Hospital)0000-0001-9640-2714
Yıldız Akdaş Reis(UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES)0000-0001-9345-6899
Asya Kalaycı Öncü(UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES)0000-0001-8582-6175
Sena Ünlü(UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES)0009-0002-5652-4543
Vakkas Korkmaz(Etlik City Hospital)0000-0001-8895-6864
Yaprak Ustun(UNIVERSITY OF HEALTH SCIENCES, ANKARA ETLİK ZÜBEYDE HANIM HEALTH RESEARCH CENTER FOR GYNECOLOGICAL DISEASES)0000-0002-1011-3848
Pages
—
Publication Date
2025-12-25
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

The overall findings suggest that LH is a safe and effective alternative to AH in obese patients.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: This study aimed to evaluate surgical outcomes associated with laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) in obese women.
📊
Key Findings & Data: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.
💡
Conclusion & Impact:The overall findings suggest that LH is a safe and effective alternative to AH in obese patients.
🔬Design:Review & Systematic Survey
📍Scope:2018 Verileri
⚙️Variables:Body mass index · hysterectomy · laparoscopy

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.

Özet

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.

🔖

Cite This Article

Akay, A., Reis, Y. A., Öncü, A. K., Ünlü, S., Korkmaz, V., Ustun, Y. (2025). Hysterectomy for Benign Indications in Obese Women: Laparoscopic or Abdominal Approach?. Düzce Tıp Fakültesi Dergisi, Volume: 27 Issue: 3. https://doi.org/10.18678/dtfd.1677200

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (24)

  1. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387(10026):1377-96.
  2. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022;7(9):e009773.
  3. Tyan P, Amdur R, Berrigan M, Robinson H, Sparks A, Gu A, et al. Differences in postoperative morbidity among obese patients undergoing abdominal versus laparoscopic hysterectomy for benign indications. J Minim Invasive Gynecol. 2020;27(2):464-72.
  4. Harvey SV, Pfeiffer RM, Landy R, Wentzensen N, Clarke MA. Trends and predictors of hysterectomy prevalence among women in the United States. Am J Obstet Gynecol. 2022;227(4):611.e1-12.
  5. Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra AR, Jansen FW. Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet. 2015;292(4):723-38.
  6. Matsuo K, Mandelbaum RS, Nusbaum DJ, Matsuzaki S, Klar M, Roman LD, et al. National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA. Acta Obstet Gynecol Scand. 2021;100(3):459-70.
  7. Tyan P, Hawa N, Carey E, Urbina P, Chen FR, Sparks A, et al. Trends and perioperative outcomes across elective benign hysterectomy procedures from the ACS-NSQIP 2007-2017. J Minim Invasive Gynecol. 2022;29(3):365-74.e2.
  8. Brunes M, Johannesson U, Häbel H, Söderberg MW, Ek M. Effects of obesity on peri- and postoperative outcomes in patients undergoing robotic versus conventional hysterectomy. J Minim Invasive Gynecol. 2021;28(2):228-36.
  9. Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2023;8(8):CD003677.
  10. O'Hanlan KA, Emeney PL, Frank MI, Milanfar LC, Sten MS, Uthman KF. Total laparoscopic hysterectomy: making it safe and successful for obese patients. JSLS. 2021;25(2):e2020.00087.
  11. Lower AM, Hawthorn RJ, Ellis H, O'Brien F, Buchan S, Crowe AM. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological operatives: an assessment from the Surgical and Clinical Adhesions Research Study. BJOG. 2000;107(7):855-62.
  12. Wang PY, Lee YC, Liu WM, Chen CH. Surgical outcome of benign cases with pelvic adhesions undergoing robotic total hysterectomy. J Chin Med Assoc. 2022;85(8):853-58.
  13. Sehnal B, Klat J, Herboltova P, Hanacek J, Fanta M, Valha P, et al. Comparison of complications in very obese women undergoing hysterectomy - Abdominal vs laparoscopic approach with short- and long-term follow-up. Eur J Obstet Gynecol Reprod Biol. 2022;276:148-53.
  14. Agarwal M, Sinha S, Haripriya H, Kokkayil P, Singh S. Surgical site infection in laparoscopic hysterectomy versus abdominal hysterectomy in gynecological disease(s): an overview. Gynecol Minim Invasive Ther. 2023;13(1):25-9.
  15. Lim CS, Mowers EL, Mahnert N, Skinner BD, Kamdar N, Morgan DM, et al. Risk factors and outcomes for conversion to laparotomy of laparoscopic hysterectomy in benign gynecology. Obstet Gynecol. 2016;128(6):1295-305.
  16. Wei G, Harley F, O'Callaghan M, Adshead J, Hennessey D, Kinnear N. Systematic review of urological injury during caesarean section and hysterectomy. Int Urogynecol J. 2023;34(2):371-89.
  17. Llarena NC, Shah AB, Milad MP. Bowel injury in gynecologic laparoscopy: a systematic review. Obstet Gynecol. 2015;125(6):1407-17.
  18. Balcı O. Comparison of total laparoscopic hysterectomy and abdominal hysterectomy. Turk J Obstet Gynecol. 2014;11(4):224-7.
  19. Macciò A, Chiappe G, Kotsonis P, Nieddu R, Lavra F, Serra M, et al. Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures. Arch Gynecol Obstet. 2016;294(3):525-31.
  20. Committee Opinion No 701: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2017;129(6):e155-59.
  21. Mamik MM, Kim-Fine S, Yang L, Sharma V, Gala R, Aschkenazi S, et al. Hysterectomy techniques and outcomes for benign large uteri: a systematic review. Obstet Gynecol. 2024;144(1):40-52.
  22. Bretschneider CE, Frazzini Padilla P, Das D, Jelovsek JE, Unger CA. The impact of surgeon volume on perioperative adverse events in women undergoing minimally invasive hysterectomy for the large uterus. Am J Obstet Gynecol. 2018;219(5):490.e1-8.
  23. Silasi DA, Gallo T, Silasi M, Menderes G, Azodi M. Robotic versus abdominal hysterectomy for very large uteri. JSLS. 2013;17(3):400-6.
  24. O'Hanlan KA, McCutcheon SP, McCutcheon JG. Laparoscopic hysterectomy: impact of uterine size. J Minim Invasive Gynecol. 2011;18(1):85-91.