Obesity: an indication rather than contraindication to laparoscopic cholecystectomy

Obesity was originally designated as a contraindication to laparoscopic cholecystectomy; however, as experience in the procedure develops, it is evolving into an indication. Out of the first 325 consecutive patients undergoing laparoscopic cholecystectomy, 91 were determined to be either obese or morbidly obese. Group I (normal body habitus), consisted of 228 patients, group II (obese) 67 patients, and group III (morbidly obese) 24 patients. Six patients were excluded because of inadequate follow-up data. The groups were fairly well matched for age and seemed to differ only in height and weight. Operative time was similar in groups I and II, while it was approximately 23% longer for group III. The outcome of surgery was compared with respect to conversion to open cholecystectomy, postoperative complications, mortality, length of postoperative stay, and return to normal activity. None of the differences were statistically significant with the exception of the slightly longer length of time for laparoscopic cholecystectomy in the morbidly obese. Laparoscopic cholecystectomy is a safe and effective treatment for obese patients and even for morbidly obese patients, and should be the procedure of choice for these patients, avoiding complications of prolonged bedrest and wound complications, so common in these patients.