[Laparoscopic cholecystectomy in morbid obesity].
In the early days of laparoscopic cholecystectomy (LC) morbid obesity was considered a relative contraindication for this procedure. With increased 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 was attempted between January 1991 and January 1992. Conversion to open cholecystectomy was necessary in 26 cases (19%). The remaining patients were divided into two groups. Group 1 consisted of 92 normal or slightly obese individuals, whereas 18 morbidly obese patients were included in group 2. Intraoperative problems (42% vs 61%) and postoperative morbidity (2% vs 11%) were less frequent in group 1, although not statistically significant. There was no difference in operating time (median for both groups: 110 minutes) and length of hospital stay (4 days). The incidence of late complications (3% vs 6%) was similar. We conclude that LC in morbidly obese patients, as in open surgery, is technically more demanding than in normal individuals. The operative risk was elevated (p < 0.05) as evidenced by a tendency to higher intra- and postoperative complication rates. Cholecystolithiasis in morbidly obese patients is a good indication for LC in the hands of well trained laparoscopic surgeons who are ready to convert to open surgery if problems arise.
Glättli
A
A
Universitätsklinik für Viszerale und Transplantationschirurgie, Inselspital Bern.
Allemann
A
A
Metzger
A
A
Barras
J P
JP
Baer
H U
HU
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors
Laparoskopische Cholezystektomie bei erheblicher Adipositas.