Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Oct;292(4):723-38.
doi: 10.1007/s00404-015-3680-7. Epub 2015 Mar 13.

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Mathijs D Blikkendaal  1 , Evelyn M Schepers, Erik W van Zwet, Andries R H Twijnstra, Frank Willem Jansen
Affiliations

Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies

Mathijs D Blikkendaal et al. Arch Gynecol Obstet. 2015 Oct.

Abstract

Purpose: Some studies suggest that also regarding the patient with a body mass index (BMI) ≥35 kg/m(2) the minimally invasive approach to hysterectomy is superior. However, current practice and research on the preference of gynaecologists still show that the rate of abdominal hysterectomy (AH) increases as the BMI increases. A systematic review with cumulative analysis of comparative studies was performed to evaluate the outcomes of AH, laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) in very obese and morbidly obese patients (BMI ≥35 kg/m(2)).

Methods: PubMed and EMBASE were searched for records on AH, LH and VH for benign indications or (early stage) malignancy through October 2014. Included studies were graded on level of evidence. Studies with a comparative design were pooled in a cumulative analysis.

Results: Two randomized controlled trials, seven prospective studies and 14 retrospective studies were included (2232 patients; 1058 AHs, 959 LHs, and 215 VHs). The cumulative analysis identified that, compared to LH, AH was associated with more wound dehiscence [risk ratio (RR) 2.58, 95 % confidence interval (CI) 1.71-3.90; P = 0.000], more wound infection (RR 4.36, 95 % CI 2.79-6.80; P = 0.000), and longer hospital admission (mean difference 2.9 days, 95 % CI 1.96-3.74; P = 0.000). The pooled conversion rate was 10.6 %. Compared to AH, VH was associated with similar advantages as LH.

Conclusions: Compared to AH, both LH and VH are associated with fewer postoperative complications and shorter length of hospital stay. Therefore, the feasibility of LH and VH should be considered prior the abdominal approach to hysterectomy in very obese and morbidly obese patients.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flowchart of the search and exclusion algorithm. Asterisk i.e. review, case report, cadaver studies. Double dagger e.g. panniculectomy. Yen sign including mean BMI <40 kg/m2 if range not specified
Fig. 2
Fig. 2
AH vs. LH, overall complication rate
Fig. 3
Fig. 3
AH vs. LH, intraoperative complication rate
Fig. 4
Fig. 4
AH vs. LH, wound problem
Fig. 5
Fig. 5
AH vs. LH, wound dehiscence (including vaginal cuff dehiscence)
Fig. 6
Fig. 6
AH vs. LH, wound infection
Fig. 7
Fig. 7
AH vs. LH, operating time
Fig. 8
Fig. 8
AH vs. LH, estimated blood loss
Fig. 9
Fig. 9
AH vs. LH, length of hospital stay
See this image and copyright information in PMC

References

    1. Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677. - PubMed
    1. Acholonu UC, Jr, Chang-Jackson SC, Radjabi AR, Nezhat FR. Laparoscopy for the management of early-stage endometrial cancer: from experimental to standard of care. J Minim Invasive Gynecol. 2012;19:434–442. doi: 10.1016/j.jmig.2012.02.006. - DOI - PubMed
    1. Janda M, Gebski V, Brand A, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol. 2010;11:772–780. doi: 10.1016/S1470-2045(10)70145-5. - DOI - PubMed
    1. Litta P, Fabris AM, Breda E, et al. Laparoscopic surgical staging of endometrial cancer: does obesity influence feasibility and perioperative outcome? Eur J Gynaecol Oncol. 2013;34:231–233. - PubMed
    1. Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010;11:763–771. doi: 10.1016/S1470-2045(10)70143-1. - DOI - PubMed

Publication types

LinkOut - more resources