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

Arife Akay, Yıldız Akdaş Reis, Asya Kalaycı Öncü, Sena Ünlü, Vakkaş Korkmaz, Yaprak Engin Üstün
In: Duzce Medical Journal · 2025 · vol. 27(3) , pp. 320–325 · doi:10.18678/dtfd.1677200 · W4416937666
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective study found that laparoscopic hysterectomy in obese women resulted in shorter operative times, reduced hospitalization, and fewer postoperative complications compared to the abdominal approach.

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This paper examines hysterectomy approaches in obese women requiring hysterectomy for benign indications, comparing laparoscopic versus abdominal methods with an emphasis on perioperative outcomes and postoperative morbidity. The study draws on observational data and synthesis of comparative findings reported in the literature, with obesity severity considered (e.g., very/morbidly obese cohorts), to characterize differences in morbidity by surgical route. A key limitation is that the evidence base is largely nonrandomized and subject to confounding by patient selection, surgical complexity, and baseline risk, which may influence apparent differences between approaches. Relevance to endometriosis: the paper focuses on benign indications broadly rather than endometriosis or adenomyosis specifically, and the provided text does not include explicit discussion of these conditions.

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Abstract

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.
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- NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016;387(10026):1377-96. - Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022;7(9):e009773. - Tyan P, Amdur R, Berrigan M, Robinson H, Sparks A, Gu A, et al. Differences in postoperative morbidity among obese patients undergoing abdominal versus laparoscopic hysterectomy for benign indications. J Minim Invasive Gynecol. 2020;27(2):464-72. - Harvey SV, Pfeiffer RM, Landy R, Wentzensen N, Clarke MA. Trends and predictors of hysterectomy prevalence among women in the United States. Am J Obstet Gynecol. 2022;227(4):611.e1-12. - Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra AR, Jansen FW. Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet. 2015;292(4):723-38. - Matsuo K, Mandelbaum RS, Nusbaum DJ, Matsuzaki S, Klar M, Roman LD, et al. National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA. Acta Obstet Gynecol Scand. 2021;100(3):459-70. - Tyan P, Hawa N, Carey E, Urbina P, Chen FR, Sparks A, et al. Trends and perioperative outcomes across elective benign hysterectomy procedures from the ACS-NSQIP 2007-2017. J Minim Invasive Gynecol. 2022;29(3):365-74.e2. - Brunes M, Johannesson U, Häbel H, Söderberg MW, Ek M. Effects of obesity on peri- and postoperative outcomes in patients undergoing robotic versus conventional hysterectomy. J Minim Invasive Gynecol. 2021;28(2):228-36. Details Primary Language English Subjects Obstetrics and Gynaecology Journal Section Research Article Authors Arife Akay * 0000-0001-9640-2714 Türkiye Yıldız Akdaş Reis 0000-0001-9345-6899 Türkiye Asya Kalaycı Öncü 0000-0001-8582-6175 Türkiye Sena Ünlü 0009-0002-5652-4543 Türkiye Vakkas Korkmaz 0000-0001-8895-6864 Türkiye Yaprak Ustun 0000-0002-1011-3848 Türkiye Early Pub Date December 3, 2025 Publication Date December 25, 2025 Submission Date April 15, 2025 Acceptance Date November 18, 2025 Published in Issue Year 2025 Volume: 27 Number: 3

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