325 Modified Abdominal Assess for Laparoscopic Cholecystectomy in Obese Population: Our Recommendation

Background and Aim

Conventional Umbilical access can be time consuming, surgically challenging due to inadequate ‘Critical View of Safety’ and pneumoperitoneum maintenance for high BMI patients undergoing laparoscopic cholecystectomy (LC). Assess the feasibility, safety and outcome of our modified access for patients of BMI ≥30.

Method and Technique

Prospective study of consecutive patients undergoing LC in a large DGH (2007-2022) that included age, sex, BMI, ASA, grade of operation with stay and complications were analysed. Group A: Veress needle pneumoperitoneum through Palmer’s point. After 2 litre (minimum) insufflations, optical port introduced at intersection of two imaginary lines: a 15cm oblique line starting from where the right mid-clavicular line cuts the right lower costal margin and directed medially meeting the other vertical line running 3cm to the right of midline. Remaining ports standard.

Group B (BMI <30): Conventional umbilicus entry.

Results

Group A: 543 with Female: Male 4:1 (436:107), Age 49* (16-82) years, BMI 36*(30-65), ASA 2 * (1-3), Grade 1 * (1-4), Operating time 50* (15-200) mins, PO stay 0* (0-15) day. One conversion, 2 bile leaks, 5 collections and 4 wound infections.

Group B: 1168 with Female: Male 3:1 (861:307), Age 53* (16-89) years, BMI 26 * (17-29), ASA 2* (1-3), Grade 1* (1-4), Operating time 45 *(15-240) mins, PO stay 0* (0-12) day. Ten conversions, 3 bile leaks, 5 collections, 8 wound infections, and 6 wash outs.

Conclusion

Modified LC abdominal access for obese patients allows safe quick entry with excellent ‘Critical view of Safety’ for a good outcome.

* Median