Laparoscopic cholecystectomy in the obese patient

Between September 1990 and September 1991 laparoscopic cholecystectomy (LC) was performed in 310 patients with symptomatic cholelithiasis by using a four-cannula technique. Of this group, 282 were normal or overweight (group A) and 28 were obese (group B) according to classification using the Body Mass Index. Forty-one patients had cholecystitis of varying degree. There were no deaths in this series. The conversion rate to laparotomy was 2.9% and the morbidity was 5.4%. There was no statistical difference between groups A and B in relation to the length of procedure, conversion rate, or morbidity. This small series suggests that laparoscopic access is still feasible, if at times difficult, in obese patients. Specific surgical techniques concerning instrument length and cannula placement that may be useful in obese patients are described.