The influence of obesity on post-operative complications and operative difficulty in open and laparoscopic cholecystectomy

SummaryThis prospective study explores the relationships between obesity, technical difficulty and outcome in open (OC) and laparoscopic (LC) cholecystectomy. Body mass index (BMI = kg/m2) was used to classify 332 patients undergoing OC (n = 116) or LC (n = 216) as: normal weight (NW) BMI <25, overweight (OW) BMI 25–29.9 and obese (OB) BMI ≥ 30. The operative difficulty of each operation was graded by the surgeon and all complications were recorded. The overall complication rate for all 332 patients was not affected by BMI: NW group 11/147 (7.5%), OW 15/122 (12.3%) and OB 5/63 (7.9%) (NS). Similarly, there was no evidence of worsening of outcome in OB compared with NW and OW patients undergoing laparoscopic or open cholecystectomy. Subjective assessment of operative difficulty revealed that access to the gall bladder was better (Chi-squared = 16.6, P < 0.001), dissection was easier (Chi-squared = 9.7, P < 0.001) and the whole procedure less difficult (Chi-squared = 11.5, P < 0.001) in LC compared with OC. Within the LC group access was better in NW than OB patients (Chi-squared = 11.1, P < 0.01) but other measures of technical difficulty were not affected by BMI. For OC, intra-operative bleeding was more troublesome and operations were more difficult in OW compared with NW patients (P < 0.05). BMI had no effect on the time required to complete LC (median 120 min) but in OC the operative time was significantly longer for OB (median 100 min) than NW (median 75 min, P = 0.004). The relatively long operative time for LC was due to the high on-table cholan-giogram rate (70%) in this group. The need for conversion from LC to OC (44/ 216 = 20%) reflects the early experience of the participating surgeons with LC but neither conversion rate nor bile duct injury rate (3/216 = 1.4%) were influenced by BMI. Obesity does not increase the technical difficulty or complication rate of LC and should not be regarded as a contraindication for this procedure.