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



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.


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.


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).


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.


Open cholecystectomy


Laparoscopic cholecystectomyP
Perioperative Complications
Reintubation8 (5.3%)4 (0.4%).001
Failure to wean11 (7.3%)3 (0.3%)<.001
Progressive renal failure7 (4.7%)2 (0.2%)<.001
Urinary tract infection4 (2.7%)5 (0.5%).027
Cardiac arrest3 (2%)0 (0%).003
Myocardial infarction2 (1.3%)1 (0.1%).054
Sepsis6 (4%)1 (0.1%)<.001
Septic Shock10 (6.7%)2 (0.2%)<.001
Pneumonia8 (5.3%)4 (0.4%)<.001


Session Number: Poster – Poster Presentations
Program Number: P481
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