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A retrospective review of 200 patients with acute cholecystitis, half of whom underwent open cholecystectomy and half of whom underwent laparoscopic cholecystectomy, was performed. The two groups were compared for demographic characteristics, operative course, cost of intervention, and surgical outcome. Laparoscopic cholecystectomy for acute cholecystitis was accomplished with an acceptable morbidity and provided an earlier release from the hospital and return to normal activities with a significant economic savings as compared to the traditional open approach.

Obesity was originally designated as a contraindication to laparoscopic cholecystectomy; however, as experience in the procedure develops, it is evolving into an indication. Out of the first 325 consecutive patients undergoing laparoscopic cholecystectomy, 91 were determined to be either obese or morbidly obese. Group I (normal body habitus), consisted of 228 patients, group II (obese) 67 patients, and group III (morbidly obese) 24 patients. Six patients were excluded because of inadequate follow-up data. The groups were fairly well matched for age and seemed to differ only in height and weight. Operative time was similar in groups I and II, while it was approximately 23% longer for group III. The outcome of surgery was compared with respect to conversion to open cholecystectomy, postoperative complications, mortality, length of postoperative stay, and return to normal activity. None of the differences were statistically significant with the exception of the slightly longer length of time for laparoscopic cholecystectomy in the morbidly obese. Laparoscopic cholecystectomy is a safe and effective treatment for obese patients and even for morbidly obese patients, and should be the procedure of choice for these patients, avoiding complications of prolonged bedrest and wound complications, so common in these patients.

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.

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