Influence of obesity on the patient’s recovery after laparoscopic surgery

Abstract

The influence of obesity on the recovery of patients after laparoscopic surgery is multi-faceted and complex, presenting both challenges and advantages brought by laparoscopic technology. This study assessed clinicopathologic differences and 1-year outcomes following elective laparoscopic cholecystectomy (LC) in patients with obesity and gallstone disease. Generally, obesity increases the difficulty of laparoscopic surgery and the risk of postoperative complications, thereby having a negative impact on the recovery process. However, compared with traditional open surgery, laparoscopic surgery has greatly reduced the surgical trauma and promoted their postoperative recovery. Despite these preoperative differences, obesity did not adversely affect short-term surgical outcomes after elective LC. However, LC can reduce incision-related complications in obese patients and help lower the risk of pulmonary complications. Patients can move around earlier, which is crucial for preventing thrombosis. Laparoscopic surgery has brought more recovery advantages to obese patients. Through meticulous preoperative assessment, precise intraoperative operation and good postoperative management, the negative impact of obesity factors on patients can be reduced.

Key Words: Obesity; Laparoscopic surgery; Postoperative period; Outcome assessment; Recovery

Core Tip: Laparoscopic surgery is significantly superior to open surgery in terms of safety, efficacy, and recovery, making it well-suited to the physiological characteristics of obese patients. Although it demands greater technical skill, it offers the better benefits to this patient population.

TO THE EDITOR

The number of patients with obesity is rising worldwide. Obesity affects laparoscopic surgery in multiple ways throughout the entire perioperative period—preoperatively, intraoperatively, and postoperatively[1].

THE IMPACT OF OBESITY ON LC AND POSTOPERATIVE RECOVERY

Some obese patients have impaired cardiopulmonary function and metabolic status, and some also present with comorbidities such as diabetes and hypertension[2]. These factors pose challenges in performing laparoscopic surgery. Nevertheless, compared with open surgery, laparoscopic cholecystectomy (LC) offers advantages such as smaller incisions, faster postoperative recovery, and fewer intra-abdominal adhesions.

After reading the article published by Noh et al[3], I wish to include the following comments in this editorial. When performing LC in obese patients, fat accumulation often makes exposure of the Calot’s triangle more difficult and complicates grasping and retracting the gallbladder. Challenges in exposure, unclear anatomy, and additional hemostasis steps often prolong the operation compared to non-obese patients. Abd El Maksoud et al[4] have reported that obesity significantly increases the technical difficulty of LC. Despite these issues, LC remains a safe and preferred approach for obese patients. Key factors for successful surgery include thorough preoperative imaging evaluation, optimization of the patient’s physical condition, adjustment of trocar placement according to individual anatomy, development of a sound surgical plan, enhanced wound care, and encouragement of early ambulation after surgery.

Following LC, obese patients may experience mild fat malabsorption in the early stages. However, within one to two months of recovery, most patients return to normal, and gastrointestinal function gradually improves[5]. Postoperative weight changes in obese patients depend on appetite, dietary intake, physical activity, and eating habits[6]. Overall, differences in postoperative weight change are not significant among obese patients, but their quality of life improves markedly. This is why we still recommend LC as the first-line treatment for obese patients with gallstones.

CONCLUSION

In summary, laparoscopic surgery provides significant recovery advantages for obese patients. Through careful preoperative evaluation, personalized trocar placement, precise intraoperative technique, and attentive postoperative management, the negative impacts of obesity-related factors can be minimized, helping obese patients achieve optimal outcomes.