The prevalence of obesity has increased worldwide and WHO has declared it a global epidemic. According to Rosstat data, in 2023, the prevalence of obesity among women in the Russian Federation reached 28.6%. Obesity is a risk factor for the development of many diseases, including benign and malignant diseases of the organs of the female reproductive system. The necessary surgical treatment of gynecological diseases against the background of morbid obesity often leads to various intraoperative and postoperative complications. Objective. To study the possibility of laparoscopic access and its outcome in the surgical treatment of women with reproductive system diseases with morbid obesity. Material and methods. A retrospective analysis of 218 patient medical records was performed. The general group included 79 patients who had undergone surgery for diseases of the reproductive system with morbid obesity. The second group (control) comprised 139 who had undergone surgery for diseases of the reproductive system in combination with normal and overweight, obesity of the I degree. In the general group, the average age of the patients was 50±8.84 years, the average weight was 105.6±11.27 kg, and BMI was 39.5±3.78 kg/m2 on average. In the control group, the average age was 44.8±11.6 years, average weight was 68.3±11.1 kg, and BMI averaged 25.2±4.2 kg/m2. For laparoscopic surgery, a STORZ high-resolution video system (Germany) and a BOWA power plant (Germany), including high-frequency (HF) electric, laser, and argon plasma energy, were used. The trocars with diameters of 5.5 mm and 12 mm and lengths of 68 mm, 100 mm and 150 mm were used. Statistical data processing was carried out using the Statistica 13 and MS Office Excel software. The result was considered statistically significant at p<0.05. Results. The comparative analysis demonstrated the possibility of using laparoscopic access for surgical treatment of women with reproductive system pathologies in combination with morbid obesity. The duration of surgical intervention, the volume of blood loss, the severity of pain, the duration of hospitalization had no statistically significant differences between the general (n=79) and control groups (n=139). The absence of differences in the frequency of intra- and postoperative complications proves that laparoscopic access in morbidly obese patients to be safe. The safety is ensured by preoperative patient preparation, perioperative management of the patient, use of necessary modern equipment and tools, surgical skills and experience. Conclusions. The use of laparoscopic access for performing surgical treatment of patients with reproductive system diseases in combination with morbid obesity can be considered as the preferable and safe treatment method.
Solov'eva et al. (2025) studied this question.