The rehabilitation among obese women after gynecological surgeries

Introduction: The obesity is a chronic, multifactorial disease caused by excessive accumulation of fat tissue in the organism. It is associated with many pathologies like a hypertension, coronary di-sease, diabetes mellitus and neoplasms. Obesity among gynecological patients is a serious load during the perform of the procedures and operations. It also worsen and makes more difficult the rehabilitation after the surgeries as well as causes the nursery problems. It is also estimated that the risk of postoperative complications breathing disorders, inflammation of the wounds, intravascular clots is much higher. The aim of the studies was to evaluate the frequency of obesity appearance among patients operated in the clinic of gynecological surgery, its influence on the postoperative period and the significance of physiotherapeutic proceeding in prevention of the complications connected with this period.

Material and methods: The study involved 45 obese women after abdominal laparotomy performed in the Clinic of Surgical Gynecology of the Poznan University of Medical Science. The following parameters were taken into account: age, height, weight, body mass index (BMI), chronic diseases, past gynecological surgeries, indication to surgical treatment, duration of the hospitalization and the
course of postoperative rehabilitation. Medical history of the patient, questionnaire, gynecological examination and USG were used.

Results: Among the study group 33 (73%) were women with endometrial carcinoma, 6 (13.3%) with cervical carcinoma and 6 (13.3%) with ovarian cysts. The average age was 48, the oldest patient was 72, the youngest was 21. Only 11 patient have had diet before the operation and lost average
weight of 5.8 kg, the rest (34) have never had it. The obstetrics history showed that 21 women (46.6%) delivered 2 times, 18 (40%) - one delivery, 5 (11.1%) - 3 deliveries and 1 (2.2%) had none. There were 35 (77.7%) patients with the simultaneous appearance of hypertension, diabetes mellitus and obesity (the \"X\" triad). 29 (64.4%) patients had varices and 8 (17.7%) a thrombosis. During the analysis of the patient histories, it was
found out that 9 (20%) of them, have been operated before due to gynecological indications. The frequency of the postoperative total wound dehiscence was 8.8%
(4 patients). During the pre- and postoperative rehabilitation which embraced all the patients, the biggest difficulty was to make them get up and move. Problems with getting up were noticed among 40 (88.8%) women, and the whole study group had difficulties to
move alone during first days after the procedure. Average number of hospitalization days was 10.5, the more obese the patient was, the longer took her to recover.

Conclusions: The indication and type of the surgery have no affect on the duration of hospitalization but it is significant that the obesity have a great influence on the time of the hospitalization, postoperative complications and problems in rehabilitation.