Laparoscopic cholecystectomy in morbidly obese patients

Background: Morbid obesity is generally regarded as a risk factor for lapar oscopic cholecystectomy due to increases in operative time, morbidity, and conversion rate to open cholecystectomy. The aim of this study was to evalu ate the feasibility and outcome of laparoscopic cholecystectomy (LC) in mor bidly obese patients. Methods: A total of 864 consecutive patients underwent LC at our institutio n between 1990 and 1997. This series represents a continuing policy of LC f or all comers. Data were collected prospectively. There were 659 nonobese ( NO: BMI <30 kg/m(2)), 188 obese (OB: BMI 30-40 kg/m(2)), and 17 morbidly ob ese patients (MO: BMI >40 kg/m(2)). Laparoscopic bile duct exploration was performed in 28 (4.2%), nine (4.8%), and one (5.9%) patients, respectively. Results: Obesity and morbid obesity were associated with trends toward an i ncreased conversion rate (2.3% NO; 4.3% OB; 5.9% MO), a longer operative ti me (median, 80, 85, and 107 mins, respectively), greater postoperative morb idity (14.7%, 5.9%, and 11.8%, respectively), and a reduced ability to obta in cholangiography (86.1%, 80.1%, and 71.4%, respectively). None of these d ifferences, however, were statistically significant (chi (2) test, p>0.05). Postoperative hospital stay for LC was similar for all three groups (media n, 1 day). Conclusion: LC in morbidly obese patients is a safe procedure, but it may b e associated with increased operative difficulty and morbidity, as compared with nonobese and obese patients.