Laparoscopic approach to gallstones in the morbidly obese patient

Obesity has been suggested to be a contraindication to laparoscopic cholecystectomy (LC). In our center, in which all patients presenting with symptomatic gallstones are considered to be candidates for LC, 24 of the first 325 LC candidates were retrospectively found to be morbidly obese. In all, 20 were women and 4 were men. The average age was 51 years (range 32 to 83 years); the average height and weight amounted to 72 inches and 298 pounds, respectively, for men; and 63.5 inches and 258 pounds, respectively, for women. One-third of these patients suffered from acute cholecystitis, and more than 50% had undergone prior abdominal surgery. The average duration of LC in these subjects was 114 min., which was 25% longer than that in nonobese patients. The average length of the hospital stay was 1.6 days, with patients returning to normal activities within an average of 6.5 days. There was no major morbidity and no mortality. Since obese patients tolerated LC as easily as did normal patients, we concluded that obesity is an indication rather than a contraindication to LC.