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Day case laparoscopic cholecystectomy: Safety and feasibility in obese patients
Matteo Gregori1, Michelangelo Miccini1, Daniele Biacchi1
1First Department of Surgery, "Sapienza" Medical School, Rome, Italy.
Insights
Day case laparoscopic cholecystectomy is safe and effective for obese patients. This procedure shows similar outcomes in terms of complications and readmissions compared to non-obese individuals, making it a viable option.
Area of Science:
- Surgical Innovation
- Bariatric Surgery
- Gastrointestinal Surgery
Background:
- Day-case laparoscopic cholecystectomy (DCLC) adoption varies, with obesity often being an exclusion criterion.
- Standardized criteria for DCLC patient selection are lacking.
- Obesity poses technical challenges for laparoscopic surgery, impacting DCLC feasibility.
Purpose of the Study:
- To determine the feasibility and safety of DCLC in obese patients.
- To compare DCLC outcomes between obese and non-obese patient groups.
Main Methods:
- Analysis of 730 consecutive patients suitable for DCLC.
- Patients categorized into obese (BMI ≥ 30 kg/m²) and non-obese (BMI < 30 kg/m²) groups.
- Outcomes assessed: morbidity, open conversion, hospitalization, length of stay, and readmission.
Main Results:
- No significant differences in overall morbidity or open conversion rates between obese and non-obese groups.
- Similar hospitalization rates (p=0.0533), early complications (p=0.2536), length of stay (p=0.3780), and readmission rates (p=0.4286).
Conclusions:
- DCLC is a safe and effective procedure for obese patients.
- Obese patients undergoing DCLC experience comparable morbidity, admission, and readmission rates to non-obese patients.
- Careful patient selection and a well-organized healthcare system are crucial for successful DCLC.
Introduction:
Day-case laparoscopic cholecystectomy (DCLC) is not universally adopted and its use is limited to patients selected by non-standardized criteria. Since laparoscopic cholecystectomy is considered technically more difficult in obese patients, a high body mass index (BMI) is often considered an exclusion criterion for DCLC. The aim of this research is to define the feasibility and safety of day case laparoscopic cholecystectomy in obese patients.
Presentation Of Case:
Data from 730 consecutive patients preoperatively considered suitable for DCLC were analysed. BMI was not considered as parameter of selection and patients were divided in two groups (Obese, 294; Non-obese, 436) according to a BMI ≥ 30 or < 30 kg/m2, respectively. Outcomes measured were morbidity, open conversion rates, hospitalization rates, length of hospital stay and readmission. Overall morbidity and open conversion rates were similar in both groups. No significant differences were observed among the two groups in terms of hospitalization rates (p 0.0533), early complications (p 0.2536), length of hospital stay (p 0.3780) and readmission rates (p 0.4286).
Discussion:
Day case laparoscopic cholecystectomy is a widely used surgical technique despite not routinely used in every health system. However, many factors related to the patient and procedure, as well as the expertise of surgical-anesthesiologist team, can influence the feasibility of DCLC. Moreover a well-organized health community system is necessary to protect and follow the patients up. Our readmission and complication rates showed how a day case laparoscopic cholecystectomy, if performed in the right setting, is a safe procedure also for patient with a raised BMI. We enrolled a large population of patients and the statistical analysis demonstrated no significant differences among the obese and non-obese patient regarding the primary and secondary endpoints.
Conclusions:
DCLC is a safe and effective procedure in obese patients with morbidity, hospital admission and readmission rates similar to those observed in non-obese patients.
