[Laparoscopic surgery and "massive" obesity]

Massive obesity is an important risk factor in gynecology surgery. The traumatic effect of traditional laparotomy on the parietal wall is responsible for important per and postoperative morbidity. We evaluated the feasibility and advantages of the laparoscopic approach in these patients, both in terms of surgical procedure and anesthesia.

To evaluate the technique, we reviewed four patients with massive obesity (BMI > or =40 kg/m(2)) who underwent laparoscopic surgery in our department. For each patient, we studied the cardiovascular risk factors, indications for operation, surgical technique, anesthesia conditions and follow-up.

From the surgical point of view, certain technical difficulties were noted such as the problem of exposure and coagulation difficulties for the vascular pedicles enveloped in a layer of fatty tissue. No conversion to laparotomy was necessary. From the anesthesiology point of view, unlike what was previously feared, there was a reduction in the high operative risk due to obesity, especially due to postoperative benefits. Follow-up in these four patients was uneventful.

Patients who suffer massive obesity are in a high risk category for surgery and anesthesia. This high risk group can benefit most from the advantages of laparoscopic surgery compared with open surgery.