Obesity: an indication rather than contraindication to laparoscopic cholecystectomy

Abstract

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.

Day case laparoscopic cholecystectomy in patients with high BMI: Experience from a UK centre

“…The cholecystectomy itself is no more difficult in obese patients, and a number of authors have suggested that the laparoscopic approach is better suited to patients with high BMIs than is the open approach. 7,15,17,25 The main advantages to performing LC as a day case, and therefore the driving force behind expansion of day case services, are improved patient satisfaction and improved recovery and reductions in the risk of hospital acquired infections and thromboembolic complications, as well as a reduction in the costs associated with hospital inpatient stay and the demand for inpatient beds. 12,13,28 The total cost estimate obtained from the finance department in the trust is £1986 for a day case LC, which increases to £3006 in the event of an overnight stay.…”

“…The patients were divided into four groups based on their BMI: less than 25 was not performed in any of the patients. The patients were followed up at 4-6 weeks postoperatively, either in the outpatient department by the operating surgeon or via a telephone call by a nurse specialist using a list of specified questions.…”

The impact of body mass index on outcomes after laparoscopic cholecystectomy

“…Early on in the LC era, morbid obesity was considered a contraindication [3]. Over time this has changed, and LC is now considered acceptable in morbidly obese patients [11,24]. Although some suggest that special techniques are to be employed in obese patients [13], others argue that increased experience with obese patients has led to the increased feasibility of LC in obese patients [11].…”

Laparoscopic Cholecystectomy in Obese and Non-Obese Children

“…At the introduction of laparoscopic cholecystectomy, obese patients were excluded from this approach, the larger body habitus was thought to decrease safety of the procedure [7,8]. However, more recent reports found no difference in conversion rate or complications [9,10]. It was also realized that the benefits of laparoscopic surgery, such as early mobilization and decreased hospital stay, would greatly benefit obese patients [10].…”