THOUGHTS ON THE ROLE OF LAPAROSCOPIC SURG ERY 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 te chnical difficulties are not well described, whereas we encountered so me: uncomplete retraction of intra-abdominal organs, weakness and hemo rrhagic tendency of the tissues, and most of all an insufficient pneum operitoneum in all patients pl-eventing sometime the surgical procedur e. We analyse those obstacles to propose solutions when the laparoscop ic way seems better regarding to the post-operative risk. We study the ir predictive factors, the best one beeing the thickness of the abdomi nal anterior wall, whereas the body weigh is an inadequate factor.