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

Objective: To compare perioperative surgical, medical, and financial outcomes in morbidly obese women who underwent non-descent vaginal hysterectomy (NDVH) compared to total abdominal hysterectomy (TAH) for non-prolapse indications. Patients and methods: A retrospective analysis included 117 women who underwent hysterectomies performed between January 2015 and March 2023 in Benha University Hospital. The NDVH group included 55 women. The TAH group included 62 women. Results: Both NDVH and TAH groups participants had statistically indifferent pre-operative mean hemoglobin levels, age, parity, associated comorbidities, previous pelvic and abdominal surgery involving cesarean sections, and comparable indications for hysterectomy(p>0.05), but statistically higher BMI, HBA1c preoperative serum level, and shorter preoperative hospital admission (days), all these items favoring the superiority NDVH group over the TAH group( p =0.0001). There were no statistical differences between groups as regrades operative room time, operative blood loss, intra-operative complications, removed uterine weight in grams, and the need for blood transfusion (p>0.05). While there were high statistical differences (p<0.0001) favoring outcomes of NDVH over TAH including the need for general anesthesia, wound complications percentage (1% vs 72%), shorter postoperative hospital stays, less consumption of analgesic and shorter duration needs for postoperative venous thromboembolic prophylaxis, earlier ambulation, earlier to pass flatus. Approximate charges of both procedures were encouraging the NDVH over TAH (p<0.0001). Conclusion: In morbidly obese women with non-prolapsed uteri, the NDVH should be the primary route for hysterectomy, as the NDVH results is better than the TAH results in all perioperative outcomes items.