Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy?

Abstract

Objective: The purpose of this study was to evaluate differences in outcomes on the basis of body mass index (BMI) in patients undergoing laparoscopic hysterectomy. Design: The study was a retrospective analysis. Methods: All cases of laparoscopic hysterectomy performed from May 2008 to May 2012 for benign, microinvasive cervical, early endometrial, and occult ovarian carcinoma were reviewed. There were 347 patients analyzed by BMI. As proposed by the World Health Organization classification system of obesity, patients were categorized by BMI. Ideal BMI was defined as being between 18.5 and 24.9 kg/m2, overweight was defined as having a BMI between 25 and 29.9 mg/m2, and obesity was defined as having a BMI ≥30 kg/m2. Laparoscopic surgery was completed successfully in 338 patients, and 9 patients had their surgery converted to laparotomy for findings at the surgery, not for complications relating to the surgery, and, therefore, were excluded from the analysis. Results: Mean age was 51.1 years in the ideal group, 50.45 in the overweight group, and 55.49 in the obese group. The patients' ages ranged in all the samples between 31 and 94 years (p<0.003). Mean operating time was 105.5 minutes, mean blood loss was 252 mL, and mean length of hospital stay was 2.4 days. There was not a significant difference among the three groups. Total major complication rate was 3.7% and early postoperative complication rate was 5. There was not a significant difference among the three groups. Urologic injury was present in 0.6% of all patients. Conclusions: Laparoscopic hysterectomy is feasible and safe, resulting in short hospital stay, minimal blood loss, and minimal operating time for patients in all BMI groups. The laparoscopic approach may extend the benefits of minimally invasive hysterectomy to the very obese, for whom abdominal surgery poses serious risk. (J GYNECOL SURG 30:74)