Laparoscopic Cholecystectomy in Obese and Non-Obese Children

Abstract

Introduction: Obesity is an increasing problem in the pediatric population. Cholecystectomy, perhaps due to this trend, is also on the rise. Despite abundant data on the impact of obesity in adults, little data exists that examines the influence of obesity on surgical outcomes in children. Therefore, we reviewed our experience with laparoscopic cholecystectomy in obese children. Methods: We performed a retrospective chart review of children who underwent laparoscopic cholecystectomy between September, 2000 and June, 2009. We excluded patients who had concurrent procedures. Data was collected including patient age, sex, height, weight, co-morbidities, date of operation, indication, length of operation, length of stay, complications, and follow-up. Body mass index (BMI) was calculated and plotted on growth chart to obtain BMI percentage according to gender and age. Results: There were 251 patients identified, 132 patients were non-obese (BMI less than 85%), 49 patients were overweight (BMI=85-95%), and 70 patients were obese (BMI>95%). The mean age of the patients was 13.1 years (range 0-20), and 70% were female. The non-obese and overweight groups had no difference in age or sex; however, the obese group were older (p=0.006) and included a higher percentage of females (p=0.02). Intraoperative cholangiogram was performed in some patients, but there was no statistically significant difference between the groups. There was no difference in operative time or complications between non-obese patients and overweight or obese patients. There were 4 complications including one conversion to open in a non-obese patient for common duct exploration. Mean length of stay was 3 days (range 0-90). There was a longer mean length of stay for the non-obese patients (3.6 days) versus overweight (1.5 days) or obese (1.25 days) patients, but this was strictly due to comorbidities. Ten of the twelve patients with medical history of hemoglobinopathy or cystic fibrosis were in the non-obese group, with two patients with spherocytosis in the overweight group. No differences were found between the groups in the indication for cholecystectomy. Conclusions: Despite the known surgical challenges with overweight and obese patients, operative times, length of stay, and complication rate remain similar for children undergoing laparoscopic cholecystectomy compared to non-obese children.