Laparoscopic approach to gallstones in the morbidly obese patient

Abstract

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.

Laparoscopic resection of colon Cancer: Consensus of the European Association of Endoscopic Surgery (EAES)

“…We found no study comparing laparoscopic to open colon-cancer surgery in the obese. For laparoscopic cholecystectomy, many studies have demonstrated similar complication rates after open and laparoscopic surgery [l3, 14,15,17,18].…”

Impact of body mass index on perioperative outcomes of laparoscopic radical nephrectomy in Japanese patients with clinically localized renal cell carcinoma

“…It appears to be important to modify surgical technique to further improve surgical outcomes of LRN in obese patients. To date, several investigators have advocated technical challenges specific to laparoscopy in obese patients, including adequate insufflation of the surgical cavity, trocar insertion and maintenance and physiological complications of pneumoperitoneum 14,20,21 . For example, Fugita et al.…”

“…For example, Fugita et al. reported the usefulness of slightly greater insufflation pressures and a lateral shift in trocar sites in LRN for obese patients 20 . In addition, Berglund et al.…”

Post-operative course after conventional or laparoscopic gastroplasty in morbidly obese patients

“…The advantages of laparoscopic surgery vs. open surgery have been extensively studied for many abdominal surgical procedures [10, 11]. However, only a few studies have investigated the advantages of laparoscopic surgery in obese patients [3, 12–16]. None have specifically compared the immediate post‐operative outcomes in patients undergoing laparoscopic or open gastroplasty for morbid obesity.…”