腹腔镜胆囊切除术, 择期手术, 体重指数, 术后并发症

Objective The study aims to investigate the relationship between BMI and the short-/long-term prognosis of patients who underwent selective laparoscopic cholecystectomy (LC) for benign gallbladder disease. Methods Clinical data of patients from Department of General Surgery, the 963^rd Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, and Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, who underwent selective LC for benign gallbladder disease between Jan. 2016 and Dec. 2019 were analyzed retrospectively. The enrolled patients were divided into three groups according to their preoperative BMI: lower BMI (<18.5 kg/m²), normal BMI (18.5≤BMI<25.0 kg/m²) and higher BMI (≥25.0kg/m²). Patients’ baseline characteristics, operative variables, short-and long-term complications were compared among the three groups. Univariable and multivariable Logistic-regression analyses were performed to identify risk factors for postoperative complications after LC. Results A total of 391 patients who underwent selective LC for benign gallbladder disease were enrolled into this study. According to the preoperative BMI, they were divided into three groups: 44 in lower BMI group (11.3%), 192 in normal BMI group (49.1%) and 155 in higher BMI group (39.6%). Baseline characteristics among the three groups were comparable except for patients in higher BMI group showed a higher incidence of diabetes and higher value of aspartate aminotransferase (AST). In terms of perioperative results, there was no significant difference among the three groups in operating time, overall hospitalization time or postoperative hospitalization time (P>0.05). In terms of complications after LC, the incidence of short-term complication in lower BMI and higher BMI group was 22.7% and 23.9% respectively, significantly higher than that in the normal BMI group (8.9%, all P<0.05). However, no significant difference was found among the three groups in long-term complication incidence (lower BMI group: 4.5%; normal BMI group:4.7%; higher BMI group: 9.7%, P=0.150). In addition, further univariable and multivariable Logistic-regression analyses determined that higher and lower BMI are independent risk factors for short-term complications after selective LC, and the corresponding risk ratios were 4.1 and 2.7, respectively . Conclusion For patients receiving selective LC for benign gallbladder disease, both higher and lower BMI are responsible for higher complication incidence within 30 d after surgery . As a result, it is necessary to carry out diet control, exercise and weight loss plan for patients with higher BMI, while to strengthen nutrition and improve malnutrition status for patients with lower BMI, so that to reduce the risks of short-term complications after LC.

laparoscopic cholecystectomy, selective operation, body mass index, postoperative complication