Laparoscopic management of benign adnexal mass in
obese women
Desmond Thomas, MD, Marcos Ikeda, MD, Krishnaprasad Deepika, MD,
Carlos Medina, MD, and Peter Takacs, MD, PhD,
From the Departments of Obstetrics and Gynecology (all authors), and Anesthesiology (Dr. Deepika), Miller School of
Medicine, University of Miami.
Abstract
STUDY OBJECTIVE: To compare complications and rate of conversion to laparotomy between normal-
weight, preobese, and obese women who underwent laparoscopic management of benign adnexal mass.
DESIGN: Retrospective chart review (Canadian Task Force classification II-3).
SETTING: Tertiary care teaching hospital.
PATIENTS: One hundred seventy women who underwent laparoscopic surgery because of benign
adnexal mass were placed in three groups on the basis of their body mass index (BMI) using the World
Health Organization’s classification (normal-weight [BMI 18.5–24.9 kg/m
2
], preobese [BMI 25–29.9
kg/m
2
], and obese [BMI 30 kg/m
2
]).
INTERVENTION: Retrospective comparison of conversions from laparoscopy to laparotomy, oper-
ative time, estimated blood loss, complications, history of pelvic inflammatory disease, endometriosis,
and length of hospital stay was carried out among the different groups.
MEASUREMENTS AND MAIN RESULTS: Overall, 170 laparoscopic cases were evaluated (64 with
normal-weight, 67 preobese, and 39 obese women). The rate of conversion to laparotomy was
significantly higher in the obese and preobese groups compared with the normal-weight women (17.9%,
17.9% vs 1.5%, p .01). Obese women were 13 times more likely to undergo conversion than
normal-weight women (OR 13.78; 95% CI 1.76 –29.1). In addition, obese women had significantly
longer surgeries (143 87 minutes vs 114 41 minutes [p = .04]) and longer hospital stay (1.07
1.83 days vs 0.51 1.06 days [p = .04]) when compared with normal-weight women. There was no
significant difference in history of pelvic inflammatory disease, endometriosis, and adhesions at the
time of laparoscopy between obese, preobese, and normal-weight women. The rate of complications
was similar among the groups.
CONCLUSION: Obese and preobese women undergoing laparoscopic management of benign ad-
nexal mass were found to be at an increased risk for conversion to laparotomy, longer surgery and
longer hospital stay. Obese and preobese women should be counseled extensively on morbidity
associated with laparoscopy.
© 2006 AAGL. All rights reserved.
KEY WORDS:
Diclofenac;
Postoperative pain;
Laparoscopic surgery;
Transdermal patch
The prevalence of obesity in Western world has doubled
over the past decade, with 25% of all females in the United
States now classified as obese.
1,2
Approximately 40 million
U.S. citizens are obese, and of these, half are women.
3
Therefore, as physicians in a surgical subspecialty, we are
routinely challenged in caring for obese patients.
Over the past two decades, we have seen laparoscopy be-
come the mode of choice to perform surgical procedures tra-
ditionally done with laparotomy. More and more patients are
Presented at the 34
th
annual meeting of the AAGL, Chicago, Illinois,
November 9 –12, 2005.
Corresponding author: Peter Takacs, MD, PhD, University of Miami
School of Medicine, Department of Obstetrics and Gynecology (D-50),
Jackson Memorial Hospital, P.O. Box 016960, Miami, FL 33010.
E-mail: ptakacs@med.miami.edu
Submitted February 16, 2006. Accepted for publication March 23,
2006.
1553-4650/$ -see front matter © 2006 AAGL. All rights reserved.
doi:10.1016/j.jmig.2006.03.017
Journal of Minimally Invasive Gynecology (2006) 13, 311–314