Hysterectomy for Benign Indications in Obese Women: Laparoscopic or Abdominal Approach?

Aim: This study aimed to evaluate surgical outcomes associated with laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) in obese women. Material and Methods: A retrospective review was conducted of obese women (body mass index, BMI, >30 kg/m2) who underwent hysterectomy for benign indications between 2018 and 2022. Patients were divided into two groups based on surgical approach, LH and AH. Demographic characteristics, operative time, hospitalization day, and perioperative complications were compared. Results: A total of 425 patients were included, comprising 146 (34.4%) AH and 279 (65.6%) LH cases. The groups were comparable in mean age (49.0±6.4 vs. 47.8±5.7 years, p=0.057), though BMI was significantly higher in the LH group (33.4±3.7 vs. 32.4±2.9 kg/m2, p<0.001). The LH group demonstrated significantly shorter mean operative time (104.0±20.6 vs. 117.0±17.6 minutes, p<0.001) and also reduced median hospitalization day (2, range: 1-15, vs. 3, range: 2-14 days, p<0.001). The rate of intraoperative complications was comparable in both groups (n=5, 3.4% vs. n=2, 0.7%, p=0.050). However, a significantly higher postoperative complication rate was observed in the AH group (n=12, 8.2% vs. n=9, 3.2%, p=0.024). Conclusion: LH in obese women was associated with shorter operative time, reduced hospitalization days, and lower rates of postoperative complications compared with AH. The overall findings suggest that LH is a safe and effective alternative to AH in obese patients. Further prospective studies are required to confirm these retrospective results and control for heterogeneity.