Hysterectomy in obese women: a comparison of abdominal and vaginal routes.
OBJECTIVE
To compare perioperative outcome measures of abdominal and vaginal hysterectomies in obese women.


METHODS
We reviewed the charts of all obese women (body mass index more than 30 kg/m(2)) who underwent abdominal or vaginal hysterectomy for benign gynecologic conditions in our institution between 1997 and 2002. Laparoscopically assisted vaginal hysterectomies and hysterectomies with concomitant major pelvic or abdominal surgery were excluded. The rate of operative and postoperative complications, length of hospitalization, operative time, and perioperative change of hemoglobin concentration were analyzed for abdominal hysterectomy and vaginal hysterectomy.


RESULTS
The study group consisted of 369 obese women, of whom 189 (51.2%) underwent abdominal, and 180 (48.8%), vaginal hysterectomy. Patient characteristics were statistically comparable between the groups except for uterine weight, which was higher in the abdominal group, and parity, which was greater for women who underwent vaginal hysterectomy (P <.05). After controlling for all the significantly different variables, vaginal hysterectomy resulted in lower incidence of postoperative fever (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.12-0.39), ileus (OR 0.21, 95% CI 0.06-0.75), urinary tract infection (OR 0.21, 95% CI 0.06-0.75), shorter operative time (126.8 +/- 58.7 minutes compared with 109.7 +/- 68.5 minutes) and length of hospital stay (3.5 +/- 1.9 days compared with 1.9 +/- 1.1 days). Seven women (3.7%) who underwent abdominal hysterectomy developed wound infections during their hospital stay compared with none in the vaginal hysterectomy group.


CONCLUSIONS
For obese women, vaginal hysterectomy is superior due to its lower incidence of postoperative fever, ileus, and urinary tract infection and shorter operative time and hospital stay.


METHODS
II-2
Departments of Obstetrics, Gynecology and Reproductive Sciences and Biostatistics, Temple University School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA.
Ebru F
EF
Isik-Akbay
Ozgur H
OH
Harmanli
Uma R
UR
Panganamamula
Mustafa
M
Akbay
John
J
Gaughan
Ashwin J
AJ
Chatwani
D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data*; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data; D007902:Length of Stay; D008499:Medical Records; D008875:Middle Aged; D009765:Obesity; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications; D012189:Retrospective Studies