Obesity, is it an indication or contraindication for laparoscopic appendectomy?

ABSTRACT

Laparoscopic appendectomy [LA] has been associated with a faster recovery and less postoperative pain than the open appendectomy [OA]. The aim of this study was to assess the influence of obesity [body mass index, BMI> 25] on the outcome of laparoscopic versus open appendectomy. The records of 302 patients who underwent appendectomy for acute appendicitis [open or laparoscopic] between January 2002 and December 2004 were reviewed. Eighty-seven obese patients [BMI >/= 25] were classified into LA group. [19 patients] and OA group [86 patients]. Comparison between the patients groups and their non-obese counterparts included the age, sex, pathology of the appendix, anesthesia and operative time, complications, conversion from laparoscopic to open technique, length of hospital stay and postoperative full recovery time. Obese patients had significantly higher age [30 and 41.7 years for LA and OA groups, respectively] than non-obese patients [14.9 and 24.9 years for LA and OA groups respectively]. P< 0.01 In OA, the operating time for obese patients was significantly longer than that for non-obese patients [54 vs. 34 mm, p< 0.001]. In LA, there was no difference in operating time between the normal and overweight patients. Obese patients who underwent LA had longer anesthesia times than their OA counterparts [112 vs. 73 mm, p<0.01]. However this was not related to prolonged operating time [68 vs. 54 mm, p= 0.11]. Obese patients who underwent OA had significantly greater pain than those treated with LA [p< 0.05]. There were no significant differences between the two operating techniques in terms of complications. Hospital stay was longer for obese patients than for normal weight patients undergoing OA [4 vs. 2, p < 0.01]. Time to full recovery was greater in overweight patients subjected to OA than in the overweight patients in the LA group [21 vs. 15 days, p < 0.001]. We suggest considering overweight [BMI > 25] an indication rather than contraindication for laparoscopic appendectomy