Laparoscopic Cholecystectomy in the Super Morbidly Obese Patients

Muhammad Asad Khan, MD, Roman Grinberg, MD, Stelin Johnson, RPAC, John N Afthinos, MD, Karen E Gibbs, MD. Staten Island University Hospital

 

OBJECTIVE:

Laparoscopic cholecystectomy has been the accepted standard of care for the treatment of acute cholecystitis for over a decade. There is ongoing debate whether it is safe in the super morbidly obese patient with BMI ≥ 50 kg/m2. The current study compared the outcomes of super-obese (BMI ≥ 50 kg/m2) patients undergoing open vs. laparoscopic cholecystectomy.

METHODS:

We obtained data from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) on 1062 super-obese patients with a BMI ≥ 50 kg/m2 who underwent open and laparoscopic cholecystectomy between 2007 and 2009. The parameters analyzed included age, gender, co-morbid conditions, American Society of Anesthesiologists classification score, operative time, postoperative complications, re-operation, length of hospital stay and mortality.

RESULTS:

Among 1062 patients, 912 (85.9%) underwent laparoscopic cholecystectomy while 150 (14.1%) had open cholecystectomy. Mean age of the study population was 43.1 years and 80% were female. Among two groups, patients underwent laparoscopic procedures had significantly lower incidence of diabetes (20% vs. 36%), COPD (2.2% vs. 5.3%), HTN (44% vs. 66%) and bleeding disorder (2.9% vs. 20%). Operative time and length of hospital stay was significantly shorter in laparoscopic group as compared to open group (81 ± 40 min vs. 145±68 min and 1.7 ± 3.2 days vs. 9.2 ± 15.5 days, respectively). Nine patients (6%) in open cholecystectomy group underwent return to OR compare to only 1% patients in laparoscopic group. Similarly superficial, deep, organ space infection and wound dehiscence was significantly higher in open group, Patients in open cholecystectomy group had higher incidence of pneumonia, re-intubation, failure to wean, UTI, MI, cardiac arrest, sepsis and septic shock. Perioperative mortality was 3.3% in open cholecystectomy patients as compared to 0.2% in laparoscopic patients (p<0.01).

CONCLUSION:

Laparoscopic cholecystectomy is a safer option for super-obese patients and should be attempted in order to potentially avoid significant peri-operative complications in this high risk group.
 

Complications

Open cholecystectomy

N=150

Laparoscopic cholecystectomy P
Perioperative Complications
Reintubation 8 (5.3%) 4 (0.4%) .001
Failure to wean 11 (7.3%) 3 (0.3%) <.001
Progressive renal failure 7 (4.7%) 2 (0.2%) <.001
Urinary tract infection 4 (2.7%) 5 (0.5%) .027
Cardiac arrest 3 (2%) 0 (0%) .003
Myocardial infarction 2 (1.3%) 1 (0.1%) .054
Sepsis 6 (4%) 1 (0.1%) <.001
Septic Shock 10 (6.7%) 2 (0.2%) <.001
Pneumonia 8 (5.3%) 4 (0.4%) <.001

 


Session Number: Poster – Poster Presentations
Program Number: P481
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