[The influence of obesity on early results and quality of life of patients after chosen operations performed by laparoscopic or open methods].
BACKGROUND
Obesity usually depreciates early results of abdominal operations performed in an open way, but not always after laparoscopic operations. Aim of the study is to compare early results and quality of life after most common abdominal operations (cholecystectomy and appendectomy) performed on obese and non-obese patients.


METHODS
166 patients who were operated in academic teaching hospital, were analyzed in groups: cholecystectomy - laparoscopic (74) and open (30), appendectomy - laparoscopic (30) and open (32). Every group was divided into subgroups with normal body mass, obesity I obesity II and was assessed retrospectively and investigated by Gastrointestinal Quality of Life Index (GQLI) up to 5 months after intervention by registered nurse specialized in surgery. Number and gravity of complications were assessed as well as hospital stay and convalescence time.


RESULTS
There were 7/19 and 4/13 complications after laparoscopic vs 8/12 and 7/19 after open cholecystectomies and appendectomies respectively in groups with normal body weight (BMI 18.5-24.9kg/m2), and 28/56 and 8/20 complications after laparoscopic vs 14/18 and 9/12 after open cholecystectomies and appendectomies respectively in obese groups (above 25 kg/m2). One conversion to open surgery occured in patient with obesity I for laparoscopic cholecystectomy and one in normal body mass patient for laparoscopic appendectomy. There was one case of common bile duct lesion in obese patient during laparoscopic intervention and two cases of intestinal obstruction after open cholecystectomy in obese patients. Mean hospital stay time was 3.2 and 3.8 days after laparoscopic operations vs 5.4 and 5.4 days after open ones respectively. Mean convalescence time was 14 and 14 days after laparoscopic operations vs 21 and 14 days after open cholecystectomy and appendectomy respectively. Quality of life was significantly better after laparoscopic than open cholecystectomy in obese patients (128.4 +/- 12.7 vs 120.6 +/- 12.2 respectively) but significantly worse after laparoscopic than open appendectomy (121 +/- 15.2 vs 133.8 +/- 12.9 respectively). In groups with normal body mass differences were not significant.


CONCLUSIONS
There is the influence of obesity on number and burden of postoperative complications after laparoscopic and open operations, however laparoscopic access seems more effective. Although hospital stay time was shorter after both types of laparoscopic operations, convalescence time was shorter only after laparoscopic cholecystectomy. The choice of type of operation (open or laparoscopic) influences the quality of life of obese patients but not on those with normal body mass. Although these conclusions seem rather clear, verification of them on larger group of patients is mandatory.
Kuligowska
Anna
A
Samodzielna Pracownia Pielegniarstwa Chirurgicznego Pomorskiej Akademii Medycznej w Szczecinie, Szczecin.
Majewski
Włodzimierz D
WD
D000328:Adult; D001062:Appendectomy / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data*; D015897:Comorbidity; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies