Obesity Incurs Added Risks to Gynecological Surgery

As the overall incidence of obesity rises, the risk of surgical complications also increases, warns a new study review that urges gynecologists to be aware of these emerging problems.

Researchers at Queen Alexandra Hospital (Portsmouth, United Kingdom) found that the principal concern in surgical practice is for women with a body mass index (BMI) of more than 40 (i.e., morbid obesity). If surgery is required in such patients, the review states that they should receive counseling about the increased risk of complications, as well as the technical difficulties that may be encountered. In preparation for surgery, preoperative evaluation including a cardiovascular and respiratory history and relevant examination is needed, and weight and height should be recorded and the BMI calculated and clearly documented in the notes.

Possible risks from surgery include infection, bleeding, organ damage, thromboembolism, and surgical difficulty. In addition, there can be anesthetic problems such as airway and ventilation problems, nausea, and issues with lifting and moving the patient. The review notes that induction of anesthesia and preparation for surgery will take extra time in obese patients, and that all staff should undergo appropriate manual handling training. Every operating table, trolley, and bed should be labeled with its maximum weight capacity and special hospital beds should be available that can accommodate the weight and enable movement of the patient.

The reviewers also remind surgeons that many gynecological conditions can be treated without surgery, and that weight loss alone will improve conditions such as stress incontinence. Other conservative therapies, such as bladder retraining and physiotherapy for urinary problems, and pessaries for prolapse, should readily be considered for women who are obese. The review also states that departmental protocols and guidelines in the management of obese people are important, as is the adequate training of staff involved in their care. The study was published early online on April 18, 2011, in the Obstetrician & Gynaecologist (TOG).

"All gynecologists involved in surgery for obese women should be aware of the potential problems involved,” said study coauthor consultant gynecologist Patrick Hogston, MD. "Individual units should have a clear pathway of care and guidelines for the management of obese women and doctors should discuss with the patient the benefits and risks of the procedure and involve her in decision making.”

"Obesity is an increasing problem. It is essential that staff involved in treating obese patients are fully trained and that there are departmental protocols and guidelines in place to advise on the management of these patients,” added Jason Waugh, editor-in-chief of TOG.

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