Effect of Obesity on Patients Undergoing Vaginal Hysterectomy

Obesity is an excess of fat, specifically triglycerides, stored in adipose tissue, in relation to lean body mass. Body mass index (BMI) is a measure of weight in relation to height (Table 1). Morbid obesity affects nearly 60 million Americans and is becoming increasingly prevalent [1]. In the United States, 26% of adults are now estimated to be overweight, up from just 15% a decade ago. These rates from the Centers for Disease Control and Prevention may be an underestimation of the actual numbers because they rely on self-reported height, and women often report themselves taller than they actually are [2]. Gynecologic complications related to obesity include hirsutism, menorrhagia, endometrial cancer, breast cancer, urinary incontinence, and pelvic organ prolapse [3]. In addition, a number of medical conditions associated with obesity have a profound effect on a patient’s quality of life. These conditions include type 2 diabetes, orthopedic joint problems, and cardiovascular diseases, which in turn lead to a shorter lifespan and lost productivity [4]. There are serious social consequences as well. Isolation and depression develop as a result of obesity [5]. Hence, the gynecologic, medical, and social complications together make obesity a morbid disease state. Concurrent with the rise in obesity rates, the number of women nationwide who underwent hysterectomy in past years is at 600 000 such procedures annually [6,7]. Second only to cesarean section, hysterectomy is the most commonly performed surgical procedure in women in the United States. In the United States, 66% of hysterectomies are performed via the abdominal route, and 22% are performed vaginally [8], which is reflective of our institutions as well. Important factors in the choice of hysterectomy route include the extent of gynecologic disease and the need to perform concomitant procedures, as well as relative risks and benefits of each type of hysterectomy; patient preference; surgeon competence and preference; and available support facilities. Specifically, in the obese patient in whom hysterectomy is being considered, thorough examination and evaluation are important, including medical comorbidities, to appropriately assess perioperative risk. In obese patients at high risk, the vaginal route is associated with the lowest risk when in the hands of a competent surgeon.