LAPAROSCOPIC CHOLECYSTECTOMY IN SEVERE OB ESITY INDICATION OR CONTRAINDICATION

In early reports on the experience with laparoscopic cholecystectomy s evere obesity was considered a contraindication for this procedure. Th e prospectively documented data of 370 consecutive patients undergoing laparoscopic cholecystectomy were analysed to investigate, whether th is point of view is still justified. 35 of these 370 patients were cla ssified as being severely obese (body-mass-index greater than 33 kg/m( 2)). Median operation time was significantly longer in these patients than in the remaining patients (p < 0.05). In selected cases the opera tive technique had to be slightly modified due to extreme abdominal wa ll thickness. Dissection of Calot's triangle was not more difficult th an in non-obese patients. There was no statistically significant diffe rence concerning conversion rates between severely obese patients (11. 4%) and the other group of patients (15.5%). Also, the number of compl ications was not increased in the obese patients. Since the higher com plication rate in severely obese patients after conventional abdominal surgery is mainly due to the incision, laparoscopic cholecystectomy i s the preferable procedure to treat symptomatic gallstone disease in t hese patients.