title: Laparoscopic and vaginal approaches to hysterectomy in the obese.
abstract: OBJECTIVE
  The aim of the study was to compare surgery-related outcomes between laparoscopic (LH) and vaginal (VH) hysterectomy, performed for benign uterine disease (other than pelvic organs prolapse) in obese women.
  
  
  METHODS
  Data of consecutive obese (BMI≥30) patients undergoing LH and VH, between 2000 and 2013, were compared using a propensity-matched analysis. One hundred propensity-matched patient pairs (200 patients) undergoing LH (n=100) and VH (n=100) represented the study group.
  
  
  RESULTS
  Baseline demographic characteristics were similar between groups. Patients undergoing LH experienced similar operative time (87.5 (25-360) vs. 85 (25-240)min; p=0.28), slightly lower blood loss (100 (10-3200) vs. 150 (10-800)ml; p=0.006) and shorter length of hospital stay (1 (1-5) vs. 2 (1-5) days; p<0.001) than women undergoing VH. There was no statistically significant difference between LH and VH in complication rate (3% for VH vs. 10% for LH; OR: 3.4; 95%CI: 0.95-13.5; p=0.08). At multivariable analysis complication rates increased as BMI increase (OR: 1.01 (1.00-1.02) for 1-unit increase in BMI; p=0.05). Independently, LH correlated with reduced hospital stay (OR: 0.63 (95%CI: 0.49-0.82); p=0.001) and complication rates (OR: 0.91 (95%CI: 0.85-0.97); p=0.01).
  
  
  CONCLUSIONS
  In obese women affected by benign uterine disease LH and VH should not be denied on the basis of the mere BMI, per se. In this setting, LH upholds effectiveness of VH, improving postoperative outcomes. However, complication rate increases as BMI increase, regardless surgical route.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. Electronic address: giorgiobogani@yahoo.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.affiliation: Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Di Naro
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Pinelli
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.affiliation: Obstetrics and Gynecology Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Marconi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000601:surgery
keywords: Hysterectomy; Laparoscopy; Morbidity; Obesity; Vaginal