DIFFICULTIES AND COMPLICATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY IN OBESE AND NON-OBESE PATIENTS: A COMPARATIVE STUDY

Abstract

Introduction: Obesity is currently a worldwide lifestyle disease and is considered one of the contributing factors to cholelithiasis. For patients having symptoms of gallstone disease, in the case of acute or chronic cholecystitis and for obese people, laparoscopic cholecystectomy is considered as gold standard management. Reasons for higher conversion rate in the obese population undergoing laparoscopic cholecystectomy include difculty in cannula insertion, obscured anatomy of Calot's triangle because of excessive intraperitoneal fat, inadequate space to retract the liver, and difculty with instrument handling in an excessively thick abdominal wall. Methodology: This prospective observational study was conducted on fty patients (25 patients in each group) with prior written and informed consent. Patients aged above 18 years presenting with cholelithiasis were included in this study, over a period of 18 months. Laparoscopic cholecystectomy was done in all patients by an experienced laparoscopic surgeon. Patients were allocated into two groups based on BMI (body mass index) which was calculated using the Quetelet Index. Difculties and complications were compared between two groups in intraoperative and postoperative period. Results: Intraoperatively, obese patients were more likely to have impacted stones in hartmann's pouch (36% vs 20%, p<0.007), when compared to non-obese patients. There is a signicant difference in difculty in creating pneumoperitoneum between non-obese vs obese patients (0% vs 8%; p<0.049). Acomparison of the rest of the intraoperative and postoperative ndings was insignicant between the two groups. Postoperatively, none of the ndings were signicant between the two groups in terms of postoperative stay, average pain score, and surgical site infection. Conclusion: This study has shown that laparoscopic cholecystectomy can be performed safely in the obese patients and with favourable outcomes as seen in those patients with a normal body-mass index.