Vaginal Hysterectomy in the Obese Patient

Hysterectomy in morbidly obese women: a retrospective comparative analysis of routes vaginal versus abdominal in Benha University hospital

“…A Cochrane review on surgical approaches to hysterectomy for benign gynecologic diseases states that the vaginal approach must be considered the best choice for uterus removal because of its association with fewer complications, reduced operating time, decreased hospitalization, lower costs, and shorter convalescence compared with AH (9). Despite the demonstrated advantages of VH as a type of natural orifice surgery (17)(18)(19)(20)(21)(22)(23), VH accounts for only 23% of hysterectomies performed in the United States (7,8,9,38). The route of hysterectomy is commonly selected fitting to the experience and capability of the surgeon where the vaginal route was discovered to be unsuitable to most of gynecologic surgeon even in the USA (40) and UK (41).…”

“…Vaginal Hysterectomy (NDVH) in the morbidly obese woman is complexed by redundant vaginal tissue especially in parous obese patients rather than nulliparous obese patients, prominent buttocks, and lack of descent. To overcome such problems in morbidly obese women undergoing NDVH, gynecologic surgeon should be patient, confident, knowing how to implement available multiple techniques for peritoneal access, has the accessibility to execute the NDVH procedures with aids of new tools for vessel sealing, vaginal surgery visualization instruments and patients should be in a position for optimal visualization, (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

“…TVH was the procedure of choice by Heaney and Bonney in generalas well as in obese women. Some gynecologists go so far as to say there is no absolute contraindication to vaginal hysterectomy includes large sizes and positional limits, The FIGO prior president states that once gynecologic surgeon could visualize cervix vaginally, he should trial hysterectomy vaginally (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”

“…Wound complications have been one of the major anxieties in obese women who undergo abdominal hysterectomy as well (30)(31)(32)(33)(34)(35)39). Because vaginal hysterectomy by default abolishes the need for abdominal wounds, and sequentially wound complications, entirely, it is intuitive to suggest that the vaginal approach may be more favorable for obese women (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) , underwent hysterectomy for benign uterine diseases, the procedure was performed either vaginally or abdominally, anesthetized either generally or spinally, older than 18 years and their clinical follow-up data until completely cured or≥ 30 days postoperatively were available as well as their uteri weren't prolapsed ≥ seconddegree uterine descent even under anesthesia. We excluded women if they had one of the following criteria :(1) women with suspected malignancy, (2) women found to be second-degree uterine decent or more after execution of the anesthesia, (3) women in whom a major surgical intervention other than hysterectomy was performed, (4) cases with incomplete medical records or who failed to be followed for 30 days postoperatively.Preoperative collected parameters included age, BMI, comorbid conditions such as diabetes mellitus, hypertensive disorders, liver diseases, renal disorders, orthopedics problems, airway obstructive disorders, indications for hysterectomy, parity, hemoglobin concentration (CBC), previous abdominal or vaginal surgery and length of preoperative hospital entrance(LOPA) to control the comorbid status as uncontrolled diabetes mellitus (LOPA) as well as percentage of glycated hemoglobin A1C (HBA1C).…”

“…The vaginal route for hysterectomy is excellent to other procedures of hysterectomy in terms of patient's safety, security, economics, cosmesis, perioperative morbidity and supported over other routes by policy statements from the American College of Obstetricians and Gynecologists (ACOG), the American Association of Gynecologic Laparoscopists (AAGL), SOGC and International Society for Gynecologic Endoscopy (ISGE) (6,8,(14)(15)(16) as well as the medical literature (17)(18)(19)(20)(21)(22).…”