Impact of Body Mass Index on Clinical Outcomes of LLETZ

Background/Objectives: Large loop excision of the transformation zone (LLETZ) is used as a standard treatment for cervical dysplasia. Although obesity is associated with reduced cervical screening participation and may complicate gynecologic procedures, evidence on the impact of body mass index (BMI) on LLETZ outcomes remains limited. This study aimed to evaluate the association between BMI and clinical outcomes after LLETZ, with a particular focus on margin status. Methods: This retrospective single-center cohort study included 1397 patients who underwent LLETZ for cervical dysplasia between January 2010 and December 2024 at the Medical University of Vienna. Patients were categorized as normal-weight (BMI < 25 kg/m2) or overweight/obese (BMI ≥ 25 kg/m2). The primary outcome was margin status. Secondary outcomes included postoperative bleeding, lesion localization, histological findings, HPV status, cone depth, and surgeon status. Results: Overall, 949 patients had a BMI < 25 kg/m2 and 448 had a BMI ≥ 25 kg/m2. Negative margins were achieved in 984 patients (70.4%), with no significant difference between BMI groups. Postoperative bleeding occurred in 53 patients (3.8%) and was significantly less frequent in patients with BMI ≥ 25 kg/m2. Each 5-unit increase in BMI was associated with a 38% reduction in the odds of postoperative bleeding. BMI was not significantly associated with HPV status or histological findings. Conclusions: BMI was not associated with overall margin status after LLETZ, suggesting that overweight and obesity do not adversely affect short-term surgical outcomes in general. Further prospective studies are needed to evaluate long-term outcomes.