Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy?

Background Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 32; no. 11; pp. 4632 - 4638
Main Authors:	Bulian, Dirk R., Knuth, Jurgen, Thomaidis, Panagiotis, Rieger, Anna, Seefeldt, Claudia Simone, Lange, Jonas, Meyer, Jurgen, Stroehlein, Michael A., Heiss, Markus M.
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-11-2018 Springer Nature B.V
Subjects:	Abdominal Surgery Body Mass Index Cholecystectomy Cholecystectomy, Laparoscopic - adverse effects Cholecystectomy, Laparoscopic - methods Female Gallbladder Diseases - complications Gallbladder Diseases - surgery Gastroenterology Germany Gynecology Hepatology Humans Length of Stay - statistics & numerical data Medicine Medicine & Public Health Middle Aged Natural Orifice Endoscopic Surgery - adverse effects Natural Orifice Endoscopic Surgery - methods Obesity Obesity, Morbid - complications Obesity, Morbid - diagnosis Outcome and Process Assessment, Health Care Postoperative Complications - epidemiology Postoperative Complications - etiology Proctology Retrospective Studies Surgery Vagina - surgery Germany Obesity NOTES Body mass index Transvaginal cholecystectomy Complications
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Summary:	Background Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed and compared the outcomes of the procedure with obese and non-obese patients. Methods Data from a prospectively maintained database were retrospectively analyzed. All the TVCs performed in our clinic since 2008 were divided into groups according to their body mass index (BMI). Within these groups, we evaluated the following outcome parameters: age, ASA classification, procedural time, number of percutaneous trocars, intra- and postoperative complications, and postoperative hospital stay. Additionally, the posthospital surgical and gynecological follow-up was evaluated for additional complications and patients with class III obesity were contacted to determine further parameters. Results Six underweight, 76 normal weight, 72 overweight, 48 class I obesity, 15 class II obesity, and 20 class III obesity patients were analyzed. ASA classification ( P < 0.001), procedural time ( P < 0.001), and number of percutaneous trocars ( P < 0.001) significantly increased with the BMI. By contrast, intra- and postoperative complications ( P = 0.134 and P = 0.571), as well as postoperative hospital stay ( P = 0.076) did not depend on the BMI. Neither did the classification according to Clavien/Dindo show a significant relation ( P = 0.640). Lethality was zero. All posthospital gynecological follow-ups were inconspicuous. Telephone follow-up of class III obesity patients reached a rate of 85% after median 3.4 years. There were no additional complications or problems during sexual intercourse. The satisfaction with the cosmetic and the overall result was very high. Conclusions Although the results of existing studies including normal-weight or merely moderately obese patients can hardly be applied to morbidly obese patients, especially regarding procedural time and the number of percutaneous trocars, obesity should not be an exclusion criterion for TVC, regardless of its magnitude.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0930-2794 1432-2218 1432-2218
DOI:	10.1007/s00464-018-6216-y