The role of laparoscopy in the treatment of morbid obesity.
BACKGROUND
Laparoscopic surgery was established as a regular surgical technique 11 years ago. There are still some controversies among surgeons about the benefits of this method.


METHODS
A retrospective 3-year analysis of immediate and long-term complication rates, hospitalization length, and weight loss following laparotomic and laparoscopic nonadjustable gastric banding in 150 and 145 patients, respectively, was undertaken. Some of the criteria usually used for comparison of results in laparotomy and laparoscopy in general surgery were used in this analysis as background for the comparison of the two groups of obese patients. One example of the different results of the laparotomic and laparoscopic approaches in bariatric surgery was provided by obese monozygotic twins who underwent surgery the same day in our department, one by laparotomy and the other by laparoscopy. There was a significant difference in hospitalization length, in required postoperative analgesia, and in levels of c-reactive protein.


RESULTS
There was no statistical difference in intraoperative complication rates in the two groups, but there was a significant difference in immediate and long-term postoperative complications of wound discharge and incisional hernias. The obese twins illustrate the significant difference in postoperative c-reactive protein levels and in length of operating time and hospitalization in favor of laparoscopy, and this difference supports our results in much larger groups of genetically unrelated patients who were studied.


CONCLUSIONS
At the end of the 10-year period of laparoscopic surgery for bariatric procedures, the results were impressive. The laparoscopic approach to surgery for morbid obesity was of considerable value in terms of low morbidity and mortality.
Fried
M
M
First Surgical Department, Faculty General Hospital, Charles University, Prague, Czech Republic.
Pĕsková
M
M
Kasalický
M
M
D000328:Adult; D003365:Costs and Cost Analysis; D018153:Czech Republic; D004200:Diseases in Twins / Q000628:therapy; D005260:Female; D015391:Gastroplasty / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome; D014430:Twins, Monozygotic