[Thoughts on the role of celiosurgery in patients with major obesity]

Is coelioscopic surgery an interesting way in massive obese patients? This is well established concerning the post-operative benefit, with a decreased risk of pulmonary and thrombo-embolic complications. But technical difficulties are not well described, whereas we encountered some: incomplete retraction of intra-abdominal organs, weakness and hemorrhagic tendency of the tissues, and most of all an insufficient pneumoperitoneum in all patients preventing sometime the surgical procedure. We analyse those obstacles to propose solutions when the laparoscopic way seems better regarding to the post-operative risk. We study their predictive factors, the best one being the thickness of the abdominal anterior wall, whereas the body weigh is an inadequate factor.