Modifications of celiotomy techniques to decrease morbidity in obese gynecologic patients

Celiotomy techniques have been modified in an attempt to decrease the wound complication rates at our institution. During a 5-year period, 1044 patients underwent celiotomy and major surgical procedures, usually hysterectomy and bilateral salpingo-oophorectomy. Wound complications were noted in eight of 900 nonobese patients. Of obese patients not operated upon by the protocol, 42.2% had wound complications. Obese patients operated upon according to protocol had a wound complication rate of 3.1%. The difference in wound complication rate in obese, non-protocol operation patients as compared to the obese, protocol operation patients was highly significant (p less than 0.0001). The techniques used minimized wound infections in obese patients.