Abstract
Abstract
Objectives
The challenges posed by laparoscopic cholecystectomy (LC) in obese patients and the methods of overcoming them have been addressed by many studies. However, no objective tool of reporting operative difficulty was used to adjust the outcomes and compare studies. The aim of this study was to establish whether obesity adds to the difficulty of LC and laparoscopic common bile duct exploration (LCBDE) and affects their outcomes on a specialist biliary unit with a high emergency workload.
Methods
A prospectively maintained database of 4699 LCs and LCBDEs performed over 19 years was analysed. Data of patients with body mass index (BMI) ≥ 35, defined as grossly obese, was extracted and compared to a control group.
Results
A total of 683 patients (14.5%) had a mean BMI of 39.9 (35–63), of which 63.4% met the definition of morbidly obese. They had significantly more females and significantly higher ASA II classifications. They had equal proportions of emergency admissions, similar incidence of operative difficulty grades 4 or 5 and no open conversions and were less likely to undergo LCBDE than non-obese patients. There were no significant differences in median operative times, morbidity, readmission or mortality rates.
Conclusions
This study, the first to classify gall stone surgery in obese patients according to operative difficulty grading, showed no difference in complexity when compared to the non-obese. Refining access and closure techniques is key to avoiding difficulties. Index admission surgery for biliary emergencies prevents multiple admissions with potential complications and should not be denied due to obesity.
Publisher
Springer Science and Business Media LLC
Reference39 articles.
1. World Health Organization. Obesity and overweight. 2006. Available at: www.who.int/mediacentre/factsheets/fs311/en/index.html. Accessed 30/11/2021
2. National Institute for Health and Clinical Excellence (NICE). Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children. 2006. Available at: www.nice.org.uk/guidance/CG43. Accessed 30/11/2021
3. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA. 2003;289:76–79.
4. Webber L, Divajeva D, Marsh T,et al. The future burden of obesity-related diseases in the 53 WHO European-Region countries and the impact of effective interventions: a modelling study. BMJ Open. 2014;4:e004787.
5. Bhaskaran K, Douglas I, Forbes H, et al. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5•24 million UK adults. Lancet. 2014 Aug 30;384(9945):755-765. https://doi.org/10.1016/S0140-6736(14)60892-8. Epub 2014 Aug 13.
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献