[Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications?]

In early reports on the experience with laparoscopic cholecystectomy severe obesity was considered a contraindication for this procedure. The prospectively documented data of 370 consecutive patients undergoing laparoscopic cholecystectomy were analysed to investigate, whether this point of view is still justified. 35 of these 370 patients were classified as being severely obese (body-mass-index greater than 33 kg/m2). Median operation time was significantly longer in these patients than in the remaining patients (p < 0.05). In selected cases the operative technique had to be slightly modified due to extreme abdominal wall thickness. Dissection of Calot's triangle was not more difficult than in non-obese patients. There was no statistically significant difference concerning conversion rates between severely obese patients (11.4%) and the other group of patients (15.5%). Also, the number of complications was not increased in the obese patients. Since the higher complication rate in severely obese patients after conventional abdominal surgery is mainly due to the incision, laparoscopic cholecystectomy is the preferable procedure to treat symptomatic gallstone disease in these patients.