title: Laparoscopic cholecystectomy in the obese: results with the traditional and fundus-first technique.
abstract: BACKGROUND
  The aim of this study was to assess retrospectively the results of laparoscopic cholecystectomy (LC) performed in obese patients at our institution with the traditional technique and with the fundus-first (FF) technique.
  
  
  METHODS
  We performed a retrospective analysis of 194 obese patients that underwent LC between 1994 and December 2007 at our institution. Surgical techniques were compared with respect to operative times, conversion to open cholecystectomy, postoperative complications, mortality, and length of postoperative stay.
  
  
  RESULTS
  In the reviewed period, LC was performed in 113 (58.2%) patients with obesity type I (OTI), 55 (28.3%) patients with obesity type II (OTII), and 26 (13.5%) patients with obesity type III (OTIII). None of the differences among obese groups treated with the two techniques were statistically significant, with the exception of the lower operative times in the OTIII patients treated with the FFLC. The median operating time in the OTIII group was, respectively, 90 minutes for traditional LC and 65 (range, 45-130) for FFLC (P < 0.05).
  
  
  CONCLUSIONS
  This study achieved to conclude that LC in the obese is a safe, feasible, and efficient operation, but remains a demanding procedure even in experienced hands. FFLC can support the traditional LC in the treatment of obese patients, yielding a complication rate comparable with the traditional technique. In our study, it significantly reduced the operative time in OTIII patients, simplifying all the intra-abdominal maneuvers and the gallbladder dissection.
authors.affiliation: Department of General and Vascular Surgery, Sant'Elena Clinic, Quartu Sant'Elena, Cagliari, Italy. massimiliano.tuveri@libero.it
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Tuveri
authors.forename: Valentina
authors.initials: V
authors.lastname: Borsezio
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.forename: Augusto
authors.initials: A
authors.lastname: Tuveri
authors.forename: Angelo
authors.initials: A
authors.lastname: Nicolosi
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome