Impact of morbid obesity on outcome of laparoscopic splenectomy.
BACKGROUND
Because of the obesity epidemic, surgeons are operating on morbidly obese patients in increasing numbers. The aim of this study was to evaluate the impact of morbid obesity on the outcome of laparoscopic splenectomy.


METHODS
The study group consisted of 120 consecutive patients who underwent laparoscopic splenectomy for benign and malignant disease from March 1996 to May 2005. These patients were retrospectively divided into three groups. Group 1 had a body mass index (BMI) < 30. Group 2 patients had a BMI > or = 30 and < 40 and were considered obese. Group 3 had a BMI > or = 40 and were considered morbidly obese. Data including surgical approach (laparoscopic vs. hand-assisted), operative time, conversion rate, estimated blood loss, splenic weight, length of stay, time to tolerate a diet, pathologic diagnosis, complications, and mortality were recorded.


RESULTS
Complete data were available for evaluation of 112 patients of whom 73 (65%) had a BMI < 30, 32 (29%) had a BMI > or = 30 and < 40, and 7 (6%) had a BMI > or = 40. The most frequent indication for splenectomy in all three groups was idiopathic thrombocytopenic purpura (ITP). The operative times were significantly higher in patients with a BMI > 40. Conversion rates were also higher in this group, although this did not reach statistical significance. Patients with a BMI > 30 experienced similar complication rates when compared with patients with a BMI < 30. Only when patients had a BMI > 40 did they experience more complications.


CONCLUSIONS
Laparoscopic splenectomy was performed safely in obese patients (BMI > 30) with similar results to those of nonobese patients. Only in morbidly obese patients (BMI > 40) do outcomes and complications appear to be affected. Obesity should not be a contraindication to laparoscopic splenectomy.
Dominguez
Edward P
EP
Section of Minimally Invasive Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Choi
Yong U
YU
Scott
Bradford G
BG
Yahanda
Alan M
AM
Graviss
Edward A
EA
Sweeney
John F
JF
D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006402:Hematologic Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D007938:Leukemia / Q000453:epidemiology / Q000601:surgery; D008223:Lymphoma / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000145:classification / Q000453:epidemiology*; D012189:Retrospective Studies; D013156:Splenectomy / Q000706:statistics & numerical data*; D013158:Splenic Diseases / Q000453:epidemiology* / Q000601:surgery*; D016019:Survival Analysis; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome