An epidemiological study on complications of total laparoscopic hysterectomy in obese vs. non-obese patients at tertiary care centre
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20254297Keywords:
Intraoperative complications, Obesity, Postoperative infection, Total laparoscopic hysterectomyAbstract
Background: Total Laparoscopic Hysterectomy (TLH) is now the preferred approach for benign gynecological conditions due to reduced morbidity and faster recovery. However, obesity remains a challenge influencing surgical outcomes and complication rates. This study aimed to compare intraoperative and postoperative complications of TLH in obese versus non-obese women.
Methods: A comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Government Medical College, Akola, Maharashtra, a tertiary care centre, including 146 women undergoing TLH. Participants were divided into obese (BMI ≥30 kg/m²; n=82) and non-obese (BMI <30 kg/m²; n=64) groups. Intraoperative and postoperative parameters, including blood loss, complications, operative time, and hospital stay, were recorded and analysed using the chi-square test and t-tests.
Results: The mean age of participants was 49.8±11.7 years. Obese patients had significantly higher intraoperative blood loss (306.0±20.4 mL vs 270.8±45.4 mL; p<0.001). Mean operative duration (117.8 vs 113.3 minutes; p=0.167) and hospital stay (2.6 vs 2.5 days; p=0.477) did not differ significantly. Most surgeries (83%) were completed without complications. Bleeding (8%) and conversion to laparotomy (5%) were the common intraoperative events. Postoperative vault infections (9% vs 2%; p=0.032) and port-site infections (4% vs 0%; p=0.022) were more frequent among obese women.
Conclusions: TLH can be safely performed in obese women with outcomes comparable to non-obese patients. Although obese women had higher minor wound-related complications, major intraoperative events were not significantly different.
References
Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol. 2017;129(6):e155-e159.
Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol. 2007;19(4):337-44.
Nieboer TE, Johnson N, Lethaby A, Tavender E, Cuur E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochr Datab System Revi. 2009;(3):CD003677.
Brown J. AAGL advancing minimally invasive gynecology worldwide: statement to the FDA on power morcellation. J Minim Invasive Gynecol. 2014;21(6):970-1.
Sinha R, Sundaram M, Nikam YA, Hegde A, Mahajan C. Total laparoscopic hysterectomy with earlier uterine artery ligation. J Minim Invasive Gynecol. 2008;15(3):355-9.
WHO. Obesity and overweight, 2020. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 01 October 2025.
NFHS-5. Ministry of Health and Family Welfare, Government of India. 2021.
Fanfani F, Boruta DM, Fader AN, Vizza E, Growdon WB, Kushnir CL, et al. Feasibility and surgical outcome in obese versus nonobese patients undergoing laparoendoscopic single-site hysterectomy: a multicenter case-control study. J Minim Invasive Gynecol. 2015;22(3):456-61.
Ozdemir S, Dogan GO. Association of obesity and surgery outcomes in patients with endometrial cancer: a single-center analysis. Rev Bras Ginecol Obstet. 2022;44(12):1117-21.
Aboelezz Moselhy SN, Mohamed Zain Eldin AK, Ibrahim Mohammed Sabra AS. The impact of obesity on total laparoscopic hysterectomy outcomes: A retrospective analysis comparing class I, II obese women versus nonobese in Benha university hospital. SVU-Int J Medi Sci. 2024;7(2):169-82.
McMahon MD, Scott DM, Saks E, Tower A, Raker CA, Matteson KA. Impact of obesity on outcomes of hysterectomy. J Mini Invas Gynecol. 2014;21(2):259-65.
El Shakhs SA, Mohamed MA, Shahin MA, Eid AM. Laparoscopic versus open hysterectomies in obese patients. Int Surg J. 2018;5(12):3893-7.
O'Hanlan KA, Emeney PL, Frank MI, Milanfar LC, Sten MS, Uthman KF. Total laparoscopic hysterectomy: making it safe and successful for obese patients. J Soci Laparosc Robot Surg. 2021;25(2):e2020-00087.
Bhandari S, Agrawal P, Singh A. Body mass index and its role in total laparoscopic hysterectomy. Int Scholar Res Noti. 2014;2014(1):787604.
Heinberg EM, Crawford III BL, Weitzen SH, Bonilla DJ. Total laparoscopic hysterectomy in obese versus nonobese patients. Obstetr Gynecol. 2004;103(4):674-80.
Pande B, Pradhan P, Pradhan SK, Mansingh S, Mishra SK. Complications of total laparoscopic hysterectomy in a tertiary care center. Cureus. 2023;15(3).
Barbaresso R, Parikh S, Pasic R. Should laparoscopy be performed in the morbidly obese? an expert opinion supporting conventional laparoscopy and intraoperative considerations for the patient with obesity with benign gynaecological conditions. Gynecol Obstetr Clin Medi. 2024;4(3).
Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, et al. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. Am J Obstetr Gynecol. 2010;203(2):118-e1.
Lascano CA, Kaidar-Person O, Szomstein S, Rosenthal R, Wexner SD. Challenges of laparoscopic colectomy in the obese patient: a review. Am J Surg. 2006;192(3):357-65.
Rout D, Sinha A, Palo SK, Kanungo S, Pati S. Prevalence and determinants of hysterectomy in India. Sci Rep. 2023;13(1):14569.
Rajkumari S, Chaudhary V, Kasaudhan S, Saraswathy KN. Incidence and determinants of hysterectomy among North Indian women: An 8-year follow-up study. Front Publ Heal. 2022;10:1065081.
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.e1-611.e12.
Downloads
Published
How to Cite
Issue
Section
