The Impact of Obesity on Outcomes of Laparoscopic Cholecystectomy

Abstract

            Obesity is increasingly prevalent in Thailand and may complicate Laparoscopic Cholecystectomy (LC). This study aimed to compare operative time, conversion to open cholecystectomy, and postoperative complications among patients stratified into three BMI categories. A retrospective cross-sectional analytical study was conducted using medical records of 610 patients who underwent LC at Wanon Niwat Hospital, Sakon Nakhon Province, between June 2022 and June 2025. Data were analyzed using Independent t-test, One-way ANOVA, Fisher's exact test, and multiple linear regression to adjust for potential confounding factors.

            Of 610 patients, 315 were non-obese (BMI <25 kg/m²), 164 were Obese Class I (BMI 25–29.9 kg/m²), and 131 were Obese Class II+ (BMI ≥30 kg/m²). One-way ANOVA revealed a significant difference in operative time across the three groups (F=3.530, p=0.030). Obese Class II+ patients had a significantly longer mean operative time (39.35±19.43 min) compared with non-obese (35.03±15.92 min, p=0.015) and Obese Class I patients (34.65±17.10 min, p=0.028), whereas Obese Class I did not differ from non-obese (p=0.808). After adjusting for confounders, multiple linear regression confirmed that only Obese Class II+ was independently associated with longer operative time by 4.91 minutes (95%CI: 1.26, 8.55; p=0.008), while Obese Class I showed no significant effect (p=0.794). Conversion to open surgery and postoperative complication rates did not differ significantly across groups (p>0.05).

            Only Obese Class II+ (BMI ≥30 kg/m²) was independently associated with prolonged operative time, without increasing complications or conversion rates. LC remains safe across all BMI levels in a community hospital setting. A BMI threshold of ≥30 kg/m² should guide preoperative preparation of surgical staff and resources to optimize efficiency and patient safety.