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[Laparoscopic cholecystectomy in morbid obesity]
A Glättli1, A Allemann, A Metzger
1Universitätsklinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Schweizerische Medizinische Wochenschrift
|October 8, 1994
Summary
Morbidly obese patients undergoing laparoscopic cholecystectomy (LC) experienced higher complication rates, indicating increased operative risk. However, LC is feasible for gallstone removal in these patients with experienced surgeons.
Area of Science:
- Surgical Innovation
- Bariatric Surgery
- Gastrointestinal Surgery
Background:
- Morbid obesity was initially a contraindication for laparoscopic cholecystectomy (LC).
- Increased surgical experience has led to LC being performed in obese patients.
Purpose of the Study:
- To evaluate the impact of morbid obesity on the feasibility and outcomes of LC.
- To compare intraoperative and postoperative complication rates between morbidly obese and non-obese patients undergoing LC.
Main Methods:
- A prospective study of 136 patients who underwent attempted LC between January 1991 and January 1992.
- Patients were divided into two groups: 92 normal/slightly obese and 18 morbidly obese.
- Data collected included conversion rates, operative time, length of stay, and intra/postoperative complications.
Main Results:
- Conversion to open surgery was necessary in 19% of cases.
- Morbidly obese patients showed higher rates of intraoperative (61% vs 42%) and postoperative (11% vs 2%) complications, though not statistically significant.
- Operating time and hospital stay were similar between groups; late complication rates were also similar.
Conclusions:
- Laparoscopic cholecystectomy in morbidly obese patients is technically more demanding and carries an elevated operative risk.
- Cholelithiasis in morbidly obese patients is a good indication for LC when performed by experienced laparoscopic surgeons prepared for conversion.