LAPAROSCOPIC CHOLECYSTECTOMY IN THE CASE OF MORBID-OBESITY

In the early days of laparoscopic cholecystectomy (LC) morbid obesity was considered a relative contraindication for this procedure. With in creased experience the procedure has been used in obese patients too. To evaluate the influence of morbid obesity on feasibility and outcome of LC, we performed a prospective study in 136 patients in whom LC wa s attempted between January 1991 and January 1992. Conversion to open cholecystectomy was necessary in 26 cases (19%). The remaining patient s were divided into two groups. Group 1 consisted of 92 normal or slig htly obese individuals, whereas 18 morbidly obese patients were includ ed in group 2. Intraoperative problems (42% vs 61%) and postoperative morbidity (2% vs 11%) were less frequent in group 1, although not stat istically significant. There was no difference in operating time (medi an for both groups: 110 minutes) and length of hospital stay (4 days). The incidence of late complications (3% vs 6%) was similar. We conclu de that LC in morbidly obese patients, as in open surgery, is technica lly more demanding than in normal individuals. The operative risk was elevated (p < 0.05) as evidenced by a tendency to higher intra- and po stoperative complication rates. Cholecystolithiasis in morbidly obese patients is a good indication for LC in the hands of well trained lapa roscopic surgeons who are ready to convert to open surgery if problems arise.