الفهرس 
TYPES OF HYSTERECTOMYOnly 14 pages are availabe for public view
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Abstract
Background: Hysterectomies are considered as the most common non-obstetric operation which performed in the United States and Western countries, with 23.3% of women aged 18 years or older undergoing the procedure. Abnormal uterine bleeding (45 %), uterine prolapse (14.5 %), endometriosis (11 %), and malignancies of the genital tract (10%) are the most common reasons for hysterectomy. Obesity is the common risk factor for these diseases. Obesity prevalence has doubled since 1980 and has reached ‘epidemic’ levels across the world, challenging health care systems and economies in developed and developing countries. According to the WHO, with 1.3 billion overweight (25 < body mass index [BMI] < 30) people and 600 million obese (BMI > 30) people in the world, the obesity rate exceeds 10% for both genders. In general, open surgery in obese patients has a number of drawbacks and has a budgetary impact. Therefore, the obese patients should undergo laparoscopic hysterectomies which has less adverse impacts on health and economy.
Aim of the Work: The aim of this study is to compare between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) for benign genital diseases in the obese patients as regard to safety in the following parameters i.e. operative blood loss, conversion to laparotomy/return to theatre, postoperative hospital stay, the operative time, need for blood transfusion, organs injuries (bladder/ureter/bowel), postoperative vault hematoma, postoperative febrile disease, surgical site infection and wound dehiscence, postoperative pain and quality of life concerning about urinary, rectal and sexual functions.
Patients and Methods: This study was conducted at Ain Shams University Maternity Hospital. It included 20 obese patients undergoing total laparoscopic hysterectomy (TLH) in group A and another 20 obese patients undergoing total abdominal hysterectomy (TAH) in group B. The study duration was from July 2019 to July 2020.
Results: In this study the obese patients with benign pathology in the genital tract were divided into two groups according to approach of hysterectomy: group A contained 20 TLAs and group B contained 20 TAHs. The comparison between both groups showed statistically insignificant difference (p>0.05) as regard to clinic-demographic characteristics e.g. age, body mass index, parity, medical history, surgical history and indication of hysterectomy. However, TLH had less operative blood loss than TAH (p< 0.001). As well, TLH was less painful than TAH as illustrated by subjective visual pain scale at 6h and 24h after surgery (p< 0.001) and subjective postoperative number of analgesic ampoules (p< 0.001). Although TLH had shorter postoperative hospital stay than TAH (p< 0.001), the operating surgeon consumed significantly more time during the procedure in TLH than TAH (p< 0.001). In contrast, there was no statistically significance difference between both groups regarding to need for blood transfusion, organs injuries (bladder/ureter/ bowel), conversion to laparotomy or re-operation, postoperative vault hematoma, postoperative febrile disease, wound complications (cellulitis/pus/dehiscence/hernia) and quality of life (p>0.05).
Conclusion: The study shows that total laparoscopic hysterectomy is a safe procedure for benign lesions of the genital tract in obese patients. It has physical, technical and economic advantages. Therefore, it can replace total abdominal hysterectomy with no considerable drawbacks.