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Total Laparoscopic Hysterectomy in Obese Versus Nonobese Patients

From the Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, Louisiana; and the Division of Research, Women and Infants’ Hospital, Providence, Rhode Island.

Address reprint requests to: Dr. Benjamin Crawford III, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121; e-mail: bcrawford{at}Ochsner.org.

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/m² or greater with those whose BMI was less than 30 kg/m².

RESULTS: Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m² 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

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