By Paula Moyer
SAN DIEGO, CA -- August 6, 2004 -- Vaginal hysterectomy may be preferable to the abdominal approach for obese women, according to findings presented here July 31st at the American Urogynecologic Society 24th Annual Scientific Meeting.
"The vaginal approach was associated with a lower incidence of fever, ileus, and urinary tract infection as well as a shorter operating time and hospitalization," reported principal investigator Ebru Isik-Akbay, MD. At the time of the study, she was a resident in obstetrics-gynecology at Temple University School of Medicine in Philadelphia, Pennsylvania.
In order to compare perioperative outcome measures of abdominal and vaginal hysterectomies in obese women, the investigators retrospectively reviewed the charts of all obese women who underwent abdominal or vaginal hysterectomy for benign gynecologic conditions at their centre between 1997 and 2002. The study protocol defined obesity in the standard way, as a body mass index (BMI) exceeding 30 kg/m�. The investigators excluded laparoscopically assisted vaginal hysterectomies, as well as hysterectomies with concomitant major pelvic or abdominal surgery.
Dr. Isik-Akbay and co-investigators compared the vaginal and abdominal groups' rate of operative and postoperative complications, as well as length of hospitalization, operative time, and perioperative change of hemoglobin concentration. Among the 369 patients whose charts were reviewed, 51.22% underwent abdominal hysterectomy and 48.78% underwent vaginal hysterectomy.
The two groups differed by uterine weight and parity. The uterine weight averaged 670.41 � 821.49 grams in the abdominal group and 214.32 � 173.94 grams in the vaginal group (P < .0001). The women in the vaginal group had an average parity of 2.81 � 1.60, compared to an average of 2.31 � 1.51 for the abdominal group. The rest of the groups' patient characteristics were comparable, according to Dr. Isik-Akbay.
Patients in the vaginal hysterectomy were less likely to have postoperative fever, with an odds ratio of 0.22 (95% confidence interval [CI] 0.12, 0.39). The vaginal group was also less likely to develop ileus, with an OR 0.21 (95% CI 0.06, 0.75) and urinary tract infection, with an OR of 0.21 (95% CI 0.06, 0.75).
The vaginal group's operative time averaged 109.66 � 68.48 minutes, compared to an average of 126.75 � 58.66 minutes for the abdominal group (P < .05). The average length of hospital stay was 1.89 � 1.06 days in the vaginal group and 3.53 � 1.90 days for the abdominal group (P < .05). Seven women (3.70%) in the abdominal group developed wound infections while hospitalized; no wound infections developed in the vaginal hysterectomy group.
These differences remained significant after the investigators had adjusted for uterine weight and parity, Dr. Isik-Akbay said, noting that the findings showed advantages to vaginal hysterectomy in this population.
[Presentation title: Hysterectomy in Obese Women: A Comparison between Abdominal and Vaginal Routes. Abstract 36]