Laparoscopic Cholecystectomy in the Obese Patient

Abstract

The authors' experience with laparoscopic cholecystectomy (LC) in obese (O, n = 96) and morbidly obese (MO, n = 27) patient groups was compared with that in the normal weight (NW, n = 174) group of patients as well as the whole group (WG). There were no operative deaths. There were no significant differences between groups for any of the following: successful intraoperative cholangiography (WG, 52.2%; NW, 52.9%; O, 51.1%; MO, 55.6%), conversion to open cholecystectomy (WG, 9.6%; NW, 9.2%; O, 10.4%; MO, 11.1%), incidence of major complications (WG, 4.1%; NW, 3.4%, O, 5.2%; MO, 0%), incidence of minor complications (WG, 7.4%, NW, 7.5%; O, 6.3%; MO, 3.7%), and length of hospitalization after successful LC (WG, 1.25 days; NW, 1.31 days; O, 1.16 days; MO, 1.13 days). Duration of operation did not differ except LC in the MO group (136.4 +/- 6.9 minutes) was longer when compared with NW patients (123.0 +/- 2.9 minutes, p less than 0.05). The authors conclude LC is a safe and effective treatment for obese patients with symptomatic cholelithiasis.

Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

“…Obesity is known to make access to the peritoneal cavity difficult, thus necessitating conversion to open laparotomy. 12,13 In this study 68% had BMI≤30, and 32% patients were having BMI>30, but there was no significant difference in obese patients with regard to conversion rates and operative time (p>0.05).The reason for higher conversion rates in male patients remains unexplained, though male gender has been a significant risk factor in most series. 8,14 It has been observed that male patients have more intense inflammation or fibrosis, resulting in more difficult dissection both in the triangle of Calot's and through the plane between the GB and the liver.…”

The impact of a high body mass index on laparoscopy assisted gastrectomy for gastric cancer

“…In fact, findings have shown that obesity does not increase surgical morbidity during several simple laparoscopic procedures, such as laparoscopic cholecystectomy [22]. Furthermore, some researchers have insisted that a laparoscopic approach should be the preferred method for obese patients with these procedures [23].…”

Open–close case? New data on appendectomy in an obese patient cohort

“…There were difficulties associated with abdominal entry, insufflations of the obese abdominal wall, ventilation when positioning the patient in Trendelenburg and visualization secondary to increased intra-abdominal fat. General surgeons shared this sentiment at the time [5] and also considered obesity to be a contra indication. Interestingly, even today, 98% of Canadian surgeons believe that obesity increases operative time for colonic procedures [6].…”