O265: Laparoscopic Cholecystectomy in Class III (Morbid) Obesity

Abstract

Abstract Background High body-mass index (BMI) has been associated with increased operative-time, conversion to open surgery, and poorer perioperative outcomes. Criteria for day-surgery often includes BMI, with centers excluding patients with BMI>40kg/m2. However, as cholecystectomies are routinely performed laparoscopically with low complication rates in patients with higher BMI, this cut-off is being questioned. Objectives To examine outcomes of Laparoscopic Cholecystectomy in patients with increased BMI, particularly when comparing patients with morbid-obesity (Class-III;BMI>40 kg/m2) to those with lower BMI. Methods Data was collected between 01/01/2022 and 31/07/2023 from hospitals throughout the Aneurin-Bevan University Health-Board, South-Wales, UK. Data on BMI, surgical indication, surgical duration, length of admission, and 30-day complications, amongst others was collected. Results This study included a total of 915 patients, 77.92%female 22.08%male. Patients were placed into 5 BMI categories: BMI<25(n=98),25-29(n=255),30-34(n=253),35-39(n=176), and>40(n=133). Median BMI was 31kg/m2, median surgical duration was 79-minutes, length of stay 0-days, the complication rate was 7.3%. There were two 30-day mortalities, one in each of BMI categories <25 and 25-29. Comparing patients with BMI>40 with others showed a significantly higher surgical duration (median 90.05mins vs83.5mins;p=0.045) but no difference in complications including bile-leak (2.3%vs1.8%;p=0.1823), significant bleed (0.7%vs0.4%;p=0.4779) or bile-duct injury (0%vs0.1%;p=0.4060). Due to existing day-surgery criteria, there was significantly increased length of admission in this group (median 1vs0 days;p=0.00). Conclusion This retrospective study finds Laparoscopic Cholecystectomy safe in patients with Class-III obesity with no increased association with intraoperative or post-operative complications. Criteria for day-surgery based solely on BMI>40 appears inappropriate.