Total laparoscopic hysterectomy: impact of body mass index on outcomes

Abstract

Overviewand aims: Hysterectomy is one of the most common gynecological surgical procedures and several studies have demonstrated the multiple advantages of laparoscopic approach in general. Obesity was initially considered to be a contraindication for laparoscopy. However, this historical perspective has been disputed. The aim of this study was to assess the effect of the body mass index (BMI) on intra-operative parameters and intra and post-operative complication rates of total laparoscopic hysterectomy (TLH). Study design: A retrospective, observational, descriptive and analytic study. Population: AllTLH performed in our department, by the same surgical team, between April 2009 and March 2014,were evaluated. Methods:Medicalrecordswere reviewed for patient characteristics(BMI, age, medical and surgical history),surgical characteristics (surgical indication and concomitant procedure, uterine weight, operating time, post-operative hemoglobin variation, length of hospitalstay), and intra and post-operative complications.The datawere analyzed according to patients’BMI. Results: The study population was divided in normal BMI (n=145), overweight (n=119) and obese (n=54). Obese patients were older, more frequently postmenopausal and with more medical pathology than normal BMI patients.More than 50% of the patients had history of at least one previous abdominopelvic surgery with no differences among the groups. No significant differences were found in terms of uterine weight (217.7 ± 154.8 vs. 257.5 ± 176.1 vs. 225.4 ± 151.0 g; p> 0.05), post-operative hospital stay (1.6 ± 0.9 vs. 1.5 ± 1.0 vs. 1.5 ± 0.9 days; p> 0.05), operating time (72.2 ± 25.3 vs.77.5 ± 25.8 vs. 83.6 ± 35.3 minutes; p> 0.05) or complication rates (12.4% vs. 14.3% vs. 13.0%). Conclusions: This study demonstrates that, in qualified hands, obesity did not increase the operating time and the intra or post-operative complication rates associated with TLH. Thus, high BMI should not be considered a contraindication for this procedure