Impact of Obesity and Associated Diseases on Outcome After Laparoscopic Cholecystectomy

Abstract

Obesity is a risk factor for operative treatment. This study examined the impact of obesity and associated comorbidities on complications after laparoscopic cholecystectomy (LC). Altogether, 1581 consecutive patients with symptomatic gallstones underwent LC between the years 1995 and 2008. Preoperative data and operative outcome of the 437 obese patients [302 with body mass index (BMI) 30 to 35 kg/m² and 135 with BMI ≥ 35.1 kg/m²] and 1144 nonobese controls (BMI ≤ 29.9 kg/m²) undergoing LC were compared. The impact of obesity, diabetes, cholecystitis, coronary heart disease, pulmonary disease, hypertension, and renal insufficiency on the postoperative outcome was analyzed by using multiple logistic regression analysis. The percentage of obese patients undergoing LC did not change during the study period. Over half of obese patients (63%) had 1 or multiple comorbidities, but only 15% of the patients had an acute surgery because of cholecystitis. Conversion to open surgery was required in 11.7% of the obese patients compared with 6.1% in the nonobese controls (P=0.0003). Acute cholecystitis increased the conversions in class II and III obese patients (50%) compared with elective surgery (8.7%, P<0.001). Mortality rate was 0 in obese patients and the rate of complications, except surgical site infections, comparable with nonobese patients. In multivariate analysis, obesity or any of the comorbidities did not associate with an elevated risk for postoperative complications. In symptomatic gallstone disease, obesity and related comorbidities increased the conversion rate, but not the operative risks of LC.

Robotic single-site cholecystectomy in the obese: outcomes from a single institution

“…Our incisional hernia rate is much lower than that in the reported literature for single incision LC [18][19][20][21][22]. Obesity has been shown to be an independent risk factor for both surgical site infection and incisional umbilical hernia formation [6,8,23]. We believe that closure under direct visualization and loose approximation of the skin has led to proper fascial closures and decreased risk of wound infection in our patients.…”

“…According to a study from the Center for Disease Control and Prevention, 35.9% of Americans are considered obese with a BMI 4 30 kg/m 2 with 17.4% of those having BMI 4 35 [5]. A BMI 4 30 is associated with a 3-fold increase in the incidence of cholelithiasis and biliary disease and diabetes carries a 1.9-fold increased risk [6][7][8]. Surgeons are continually challenged with the task of operating on an increasing number of high-risk patients.…”

“…In previous studies, obesity has been identified as an independent risk factor contributing to a higher rate of conversion from laparoscopic to open surgery [6][7][8]. Farkas et al found that increased BMI was not associated with worse outcomes after LC with any increased risk of conversion to open surgery nor increased risk of perioperative complications.…”

Risk Factors and Predictive Models for Conversion of Laparoscopic Cholecystectomy to Open Surgery, and Surgical Quality Outcome Measures

“…Obese patients undergoing LC have an eightfold higher risk of CTO than non-obese patients (OR = 7.6; 95% CI: 4.1-14; P < 0.001) [52]. Compared to the nonobese patients, class I and class II-III obese patients have a two-and threefold increase in the risk of CTO (OR = 1.8; 95% CI: 1.1-2.8; P = 0.0105) and (OR = 2.7; 95% CI: 1.5-4.6; P = 0.0006), respectively [53].…”

Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre

“…8,[11][12][13] Previous studies have shown similar rates of postoperative complications in obese and nonobese groups. 7,[14][15][16][17][18][19][20][21] Indeed, the only consistent difference between the groups has been increased operating time.…”