TY - JOUR
T1 - Laparoscopic and vaginal approaches to hysterectomy in the obese
AU - Bogani, Giorgio
AU - Cromi, Antonella
AU - Serati, Maurizio
AU - Di Naro, Edoardo
AU - Casarin, Jvan
AU - Pinelli, Ciro
AU - Uccella, Stefano
AU - Leone Roberti Maggiore, Umberto
AU - Marconi, Nicola
AU - Ghezzi, Fabio
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Objective The aim of the study was to compare surgery-related outcomes between laparoscopic (LH) and vaginal (VH) hysterectomy, performed for benign uterine disease (other than pelvic organs prolapse) in obese women. Study design Data of consecutive obese (BMI ≥ 30) patients undergoing LH and VH, between 2000 and 2013, were compared using a propensity-matched analysis. One hundred propensity-matched patient pairs (200 patients) undergoing LH (n = 100) and VH (n = 100) represented the study group. Results Baseline demographic characteristics were similar between groups. Patients undergoing LH experienced similar operative time (87.5 (25-360) vs. 85 (25-240) min; p = 0.28), slightly lower blood loss (100 (10-3200) vs. 150 (10-800) ml; p = 0.006) and shorter length of hospital stay (1 (1-5) vs. 2 (1-5) days; p <0.001) than women undergoing VH. There was no statistically significant difference between LH and VH in complication rate (3% for VH vs. 10% for LH; OR: 3.4; 95%CI: 0.95-13.5; p = 0.08). At multivariable analysis complication rates increased as BMI increase (OR: 1.01 (1.00-1.02) for 1-unit increase in BMI; p = 0.05). Independently, LH correlated with reduced hospital stay (OR: 0.63 (95%CI: 0.49-0.82); p = 0.001) and complication rates (OR: 0.91 (95%CI: 0.85-0.97); p = 0.01). Conclusions In obese women affected by benign uterine disease LH and VH should not be denied on the basis of the mere BMI, per se. In this setting, LH upholds effectiveness of VH, improving postoperative outcomes. However, complication rate increases as BMI increase, regardless surgical route.
AB - Objective The aim of the study was to compare surgery-related outcomes between laparoscopic (LH) and vaginal (VH) hysterectomy, performed for benign uterine disease (other than pelvic organs prolapse) in obese women. Study design Data of consecutive obese (BMI ≥ 30) patients undergoing LH and VH, between 2000 and 2013, were compared using a propensity-matched analysis. One hundred propensity-matched patient pairs (200 patients) undergoing LH (n = 100) and VH (n = 100) represented the study group. Results Baseline demographic characteristics were similar between groups. Patients undergoing LH experienced similar operative time (87.5 (25-360) vs. 85 (25-240) min; p = 0.28), slightly lower blood loss (100 (10-3200) vs. 150 (10-800) ml; p = 0.006) and shorter length of hospital stay (1 (1-5) vs. 2 (1-5) days; p <0.001) than women undergoing VH. There was no statistically significant difference between LH and VH in complication rate (3% for VH vs. 10% for LH; OR: 3.4; 95%CI: 0.95-13.5; p = 0.08). At multivariable analysis complication rates increased as BMI increase (OR: 1.01 (1.00-1.02) for 1-unit increase in BMI; p = 0.05). Independently, LH correlated with reduced hospital stay (OR: 0.63 (95%CI: 0.49-0.82); p = 0.001) and complication rates (OR: 0.91 (95%CI: 0.85-0.97); p = 0.01). Conclusions In obese women affected by benign uterine disease LH and VH should not be denied on the basis of the mere BMI, per se. In this setting, LH upholds effectiveness of VH, improving postoperative outcomes. However, complication rate increases as BMI increase, regardless surgical route.
KW - Hysterectomy
KW - Laparoscopy
KW - Morbidity
KW - Obesity
KW - Vaginal
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U2 - 10.1016/j.ejogrb.2015.02.035
DO - 10.1016/j.ejogrb.2015.02.035
M3 - Article
C2 - 25898369
AN - SCOPUS:84928893153
VL - 189
SP - 85
EP - 90
JO - European Journal of Obstetrics, Gynecology and Reproductive Biology
JF - European Journal of Obstetrics, Gynecology and Reproductive Biology
SN - 0028-2243
ER -