ASSESSING THE CHALLENGES AND OUTCOMES OF PERFORMING LAPAROSCOPIC SURGERY IN PATIENTS WITH OBESITY AND EXPLORING TECHNIQUES TO IMPROVE SAFETY AND EFFICACY

A FARAZ; ZM JAFFER; TH KHAN; . RAFIULLAH; A GUL

doi:10.54112/bcsrj.v2024i1.1053

Authors

A FARAZ Department of General Surgery, MTI Lady Reading hospital Peshawar, Pakistan
ZM JAFFER Department of Accident and Emergency, MTI Lady Reading Hospital Peshawar, Pakistan
TH KHAN Department of Accident and Emergency, MTI Lady Reading Hospital Peshawar, Pakistan
. RAFIULLAH Department of Accident and Emergency, MTI Lady Reading Hospital Peshawar, Pakistan
A GUL Department of General Surgery, MTI Lady Reading Hospital Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2024i1.1053

Keywords:

Bariatric Surgery, Laparoscopy, Obesity, Postoperative Complications, Surgical Safety

Abstract

Obesity and the super-obesity population in the world are increasing, and an increasing number of subjects are going for bariatric surgery in an attempt to prevent the severe consequences associated with it. Objectives: The study's main objective is to assess the challenges and outcomes of performing laparoscopic surgery in patients with obesity and explore techniques to improve safety and efficacy. Methodology: This retrospective study was conducted at the General Surgery Division of MTI Lady Reading Hospital in Peshawar over four years, from 2020 to 2023. A total of 97 patients who underwent laparoscopic surgery during this period were included in the study. The subjects were chosen according to their suitability for laparoscopic procedures, with reference to the BMI standards for the definition of obesity. Results: Data were collected from 97 patients according to the study's criteria. The study included 97 patients with a mean age of 45.23 ± 3.85 years, with a gender distribution of 60% female and 40% male. The mean BMI was 34.5 kg/m², ranging from 30 to 42, indicating a population with significant obesity. In the study, intraoperative complications occurred in 15% of patients, with difficulty in visualization being the most common issue at 7%. Conversion to open surgery was necessary in 10% of cases, primarily due to inadequate visualization. Conclusion: It is concluded that performing laparoscopic surgery in obese patients presents significant challenges, including increased operative times, higher complication rates, and a greater likelihood of conversion to open surgery.

Downloads

Download data is not yet available.

References

Ghiassi S, Morton JM. Safety and efficacy of bariatric and metabolic surgery. Current obesity reports. 2020;9:159-64.

Kumbhari V, le Roux CW, Cohen RV. Endoscopic evaluation and management of late complications after bariatric surgery: a narrative review. Obesity Surgery. 2021;31:4624-33.

Abdul Wahab R, le Roux CW. A review on the beneficial effects of bariatric surgery in the management of obesity. Expert Review of Endocrinology & Metabolism. 2022;17(5):435-46.

Velardi AM, Anoldo P, Nigro S, Navarra G. Advancements in Bariatric Surgery: A Comparative Review of Laparoscopic and Robotic Techniques. Journal of Personalized Medicine. 2024;14(2):151.

Pennestrì F, Sessa L, Prioli F, Gallucci P, Ciccoritti L, Greco F, et al. Robotic vs laparoscopic approach for single anastomosis duodenal-ileal bypass with sleeve gastrectomy: a propensity score matching analysis. Updates in Surgery. 2023;75(1):175-87.

Wang L, Wang Z, Jiang T. Outcomes of totally robotic single-anastomosis duodenal–ileal bypass with sleeve gastrectomy: A large single-centre series. Asian Journal of Surgery. 2023;46(1):501-7.

Dreifuss NH, Mangano A, Hassan C, Masrur MA. Robotic revisional bariatric surgery: a high-volume center experience. Obesity Surgery. 2021;31:1656-63.

Acevedo E, Mazzei M, Zhao H, Lu X, Soans R, Edwards MA. Outcomes in conventional laparoscopic versus robotic-assisted primary bariatric surgery: a retrospective, case–controlled study of the MBSAQIP database. Surgical Endoscopy. 2020;34:1353-65.

Moon RC, Segura AR, Teixeira AF, Jawad MA. Feasibility and safety of robot-assisted bariatric conversions and revisions. Surgery for Obesity and Related Diseases. 2020;16(8):1080-5.

Cahais J, Lupinacci R, Oberlin O, Goasguen N, Zuber K, Valverde A. Less morbidity with robot-assisted gastric bypass surgery than with laparoscopic surgery? Obesity Surgery. 2019;29:519-25.

Fazl Alizadeh R, Li S, Inaba CS, Dinicu AI, Hinojosa MW, Smith BR, et al. Robotic versus laparoscopic sleeve gastrectomy: a MBSAQIP analysis. Surgical Endoscopy. 2019;33:917-22.

Shoar S, Poliakin L, Rubenstein R, Saber AA. Single anastomosis duodeno-ileal switch (SADIS): a systematic review of efficacy and safety. Obesity surgery. 2018;28:104-13.

Gray KD, Moore MD, Elmously A, Bellorin O, Zarnegar R, Dakin G, et al. Perioperative outcomes of laparoscopic and robotic revisional bariatric surgery in a complex patient population. Obesity Surgery. 2018;28:1852-9.

Milone M, Sosa Fernandez LM, Sosa Fernandez LV, Manigrasso M, Elmore U, De Palma GD, et al. Does bariatric surgery improve assisted reproductive technology outcomes in obese infertile women? Obesity Surgery. 2017;27:2106-12.

Nassar AH, Khan KS, Ng HJ, Sallam M. Operative difficulty, morbidity and mortality are unrelated to obesity in elective or emergency laparoscopic cholecystectomy and bile duct exploration. Journal of Gastrointestinal Surgery. 2022;26(9):1863-72.

Rudasill SE, Dillon D, Karunungan K, Mardock AL, Hadaya J, Sanaiha Y, et al. The obesity paradox: underweight patients are at the greatest risk of mortality after cholecystectomy. Surgery. 2021;170(3):675-81.

Enami Y, Aoki T, Tomioka K, Hakozaki T, Hirai T, Shibata H, et al. Obesity is not a risk factor for either mortality or complications after laparoscopic cholecystectomy for cholecystitis. Scientific reports. 2021;11(1):2384.

Nofal MN, Yousef AJ, Hamdan FF, Oudat AH. Characteristics of trocar site hernia after laparoscopic cholecystectomy. Scientific Reports. 2020;10(1):2868.

Nassar AH, Ng HJ, Wysocki AP, Khan KS, Gil IC. Achieving the critical view of safety in the difficult laparoscopic cholecystectomy: a prospective study of predictors of failure. Surgical endoscopy. 2021;35:6039-47.