Comparison of laparoscopic, vaginal and abdominal hysterectomy outcomes in obese patients: A retrospective analysis

Aim: Obesity is a chronic condition that is increasingly prevalent globally and poses significant risks in the context of surgical procedures. Hysterectomy is among the most commonly performed surgeries in the field of gynecology. However, there is a paucity of studies in the existing literature that compare the various hysterectomy techniques in obese women. Consequently, this study aimed to elucidate the advantages and disadvantages of abdominal, laparoscopic, and vaginal hysterectomies performed on obese patients at our institution. Material and Method: This study is a retrospective cohort analysis involving 100 patients with a body mass index exceeding 30 kg/m² who underwent hysterectomy for benign indications at the Ondokuz Mayıs University Faculty of Medicine, Department of Gynecology, between 2016 and 2020. Among these patients, 40 underwent abdominal hysterectomy, 42 underwent laparoscopic hysterectomy, and 18 underwent vaginal hysterectomy. The intraoperative and postoperative outcomes of the 100 patients who underwent hysterectomy using these three different surgical techniques were compared. Results: Laparoscopy emerged as the surgical method associated with the lowest risk of postoperative wound infection and minimal blood loss. However, it is important to note that laparoscopic hysterectomy incurs higher costs and requires a longer operative time compared to other surgical approaches. Conversely, vaginal hysterectomy is characterized by the shortest hospital stay, the least requirement for postoperative intensive care, and the lowest overall cost. Notably, the highest blood loss was observed in patients who underwent vaginal hysterectomy. In terms of operative duration, abdominal hysterectomy was identified as the most efficient approach. Conclusion: For obese patients, less invasive hysterectomy techniques, vaginal and laparoscopic methods, may enhance postoperative outcomes.