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Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy?

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Abstract

Background

Morbidly obese patients are usually excluded from studies that compare Transvaginal Hybrid-NOTES Cholecystectomy (TVC) with traditional laparoscopic cholecystectomy. Therefore, these study results cannot necessarily be transferred to this group of patients. In this study, we have analyzed and compared the outcomes of the procedure with obese and non-obese patients.

Methods

Data from a prospectively maintained database were retrospectively analyzed. All the TVCs performed in our clinic since 2008 were divided into groups according to their body mass index (BMI). Within these groups, we evaluated the following outcome parameters: age, ASA classification, procedural time, number of percutaneous trocars, intra- and postoperative complications, and postoperative hospital stay. Additionally, the posthospital surgical and gynecological follow-up was evaluated for additional complications and patients with class III obesity were contacted to determine further parameters.

Results

Six underweight, 76 normal weight, 72 overweight, 48 class I obesity, 15 class II obesity, and 20 class III obesity patients were analyzed. ASA classification (P < 0.001), procedural time (P < 0.001), and number of percutaneous trocars (P < 0.001) significantly increased with the BMI. By contrast, intra- and postoperative complications (P = 0.134 and P = 0.571), as well as postoperative hospital stay (P = 0.076) did not depend on the BMI. Neither did the classification according to Clavien/Dindo show a significant relation (P = 0.640). Lethality was zero. All posthospital gynecological follow-ups were inconspicuous. Telephone follow-up of class III obesity patients reached a rate of 85% after median 3.4 years. There were no additional complications or problems during sexual intercourse. The satisfaction with the cosmetic and the overall result was very high.

Conclusions

Although the results of existing studies including normal-weight or merely moderately obese patients can hardly be applied to morbidly obese patients, especially regarding procedural time and the number of percutaneous trocars, obesity should not be an exclusion criterion for TVC, regardless of its magnitude.

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References

  1. Zornig C, Emmermann A, von Waldenfels HA, Mofid H (2007) Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 39:913–915

    Article  CAS  Google Scholar 

  2. Borchert DH, Federlein M, Fritze-Buttner F, Burghardt J, Liersch-Lohn B, Atas Y, Muller V, Ruckbeil O, Wagenpfeil S, Graber S, Gellert K (2014) Postoperative pain after transvaginal cholecystectomy: single-center, double-blind, randomized controlled trial. Surg Endosc 28:1886–1894

    Article  Google Scholar 

  3. Bulian DR, Knuth J, Cerasani N, Sauerwald A, Lefering R, Heiss MM (2015) Transvaginal/transumbilical hybrid–NOTES–versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg 261:451–458

    Article  Google Scholar 

  4. Noguera JF, Cuadrado A, Dolz C, Olea JM, Garcia JC (2012) Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250). Surg Endosc 26:3435–3441

    Article  Google Scholar 

  5. Borchert D, Federlein M, Ruckbeil O, Burghardt J, Fritze F, Gellert K (2012) Prospective evaluation of transvaginal assisted cholecystectomy. Surg Endosc 26:3597–3604

    Article  Google Scholar 

  6. Bulian DR, Trump L, Knuth J, Siegel R, Sauerwald A, Strohlein MA, Heiss MM (2013) Less pain after transvaginal/transumbilical cholecystectomy than after the classical laparoscopic technique: short-term results of a matched-cohort study. Surg Endosc 27:580–586

    Article  Google Scholar 

  7. Hensel M, Schernikau U, Schmidt A, Arlt G (2012) Comparison between transvaginal and laparoscopic cholecystectomy—a retrospective case-control study. Zentralbl Chir 137:48–54

    Article  CAS  Google Scholar 

  8. Kilian M, Raue W, Menenakos C, Wassersleben B, Hartmann J (2011) Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study. Langenbecks Arch Surg 396:709–715

    Article  Google Scholar 

  9. Niu J, Song W, Yan M, Fan W, Niu W, Liu E, Peng C, Lin P, Li P, Khan AQ (2011) Transvaginal laparoscopically assisted endoscopic cholecystectomy: preliminary clinical results for a series of 43 cases in China. Surg Endosc 25:1281–1286

    Article  Google Scholar 

  10. Santos BF, Teitelbaum EN, Arafat FO, Milad MP, Soper NJ, Hungness ES (2012) Comparison of short-term outcomes between transvaginal hybrid NOTES cholecystectomy and laparoscopic cholecystectomy. Surg Endosc 26:3058–3066

    Article  Google Scholar 

  11. Solomon D, Shariff AH, Silasi DA, Duffy AJ, Bell RL, Roberts KE (2012) Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study. Surg Endosc 26:2823–2827

    Article  Google Scholar 

  12. van den Boezem PB, Velthuis S, Lourens HJ, Cuesta MA, Sietses C (2014) Single-incision and NOTES cholecystectomy, are there clinical or cosmetic advantages when compared to conventional laparoscopic cholecystectomy? A case-control study comparing single-incision, transvaginal, and conventional laparoscopic technique for cholecystectomy. World J Surg 38:25–32

    Article  Google Scholar 

  13. Wood SG, Dabu-Bondoc S, Dai F, Mikhael H, Vadivelu N, Roberts KE (2014) Comparison of immediate postoperative pain after transvaginal versus traditional laparoscopic cholecystectomy. Surg Endosc 28:1141–1145

    Article  Google Scholar 

  14. Zornig C, Siemssen L, Emmermann A, Alm M, von Waldenfels HA, Felixmuller C, Mofid H (2011) NOTES cholecystectomy: matched-pair analysis comparing the transvaginal hybrid and conventional laparoscopic techniques in a series of 216 patients. Surg Endosc 25:1822–1826

    Article  Google Scholar 

  15. Rothwell PM (2005) External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet 365:82–93

    Article  Google Scholar 

  16. Xu J, Xu L, Li L, Zha S, Hu Z (2014) Comparison of outcome and side effects between conventional and transvaginal laparoscopic cholecystectomy: a meta-analysis. Surg Laparosc Endosc Percutaneous Tech 24:395–399

    Article  Google Scholar 

  17. Xu B, Xu B, Zheng WY, Ge HY, Wang LW, Song ZS, He B (2015) Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: a meta-analysis. World J Gastroenterol 21:5393–5406

    Article  Google Scholar 

  18. Sodergren MH, Markar S, Pucher PH, Badran IA, Jiao LR, Darzi A (2015) Safety of transvaginal hybrid NOTES cholecystectomy: a systematic review and meta-analysis. Surg Endosc 29:2077–2090

    Article  Google Scholar 

  19. Peng C, Ling Y, Ma C, Ma X, Fan W, Niu W, Niu J (2016) Safety outcomes of NOTES cholecystectomy versus laparoscopic cholecystectomy: a systematic review and meta-analysis. Surg Laparosc Percutaneous Tech 26:347–353

    Article  Google Scholar 

  20. Shabanzadeh DM, Sorensen LT, Jorgensen T (2016) Determinants for gallstone formation—a new data cohort study and a systematic review with meta-analysis. Scand J Gastroenterol 51:1239–1248

    Article  CAS  Google Scholar 

  21. Talseth A, Ness-Jensen E, Edna TH, Hveem K (2016) Risk factors for requiring cholecystectomy for gallstone disease in a prospective population-based cohort study. Br J Surg 103:1350–1357

    Article  CAS  Google Scholar 

  22. Rosen M, Brody F, Ponsky J (2002) Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 184:254–258

    Article  Google Scholar 

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Acknowledgements

The authors thank Prof. Rolf Lefering of the Institute for Research
in Operative Medicine, Witten/Herdecke University, Cologne,
Germany, for assistance in the statistical analysis of this study, Kimberly Rossbach, Dallas, Texas, USA, Michaela Munk, Witten/Herdecke University, Witten, Germany, and Prof. Thomas Banchoff, Georgetown University, Washington D.C., USA, for proofreading.

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Authors and Affiliations

  1. Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center (CMMC), Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany

    Dirk R. Bulian, Jurgen Knuth, Panagiotis Thomaidis, Anna Rieger, Claudia Simone Seefeldt, Jonas Lange, Jurgen Meyer, Michael A. Stroehlein & Markus M. Heiss

  2. Department of General, Visceral, Vascular and Thoracic Surgery, Hospital of Kempten, Robert-Weixler-Strasse 50, 87439, Kempten, Germany

    Jurgen Knuth

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  1. Dirk R. Bulian
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  4. Anna Rieger
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  5. Claudia Simone Seefeldt
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  8. Michael A. Stroehlein
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  9. Markus M. Heiss
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Correspondence to Dirk R. Bulian.

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Disclosures

Drs. Dirk Rolf Bulian, Jurgen Knuth, Panagiotis Thomaidis, Anna Rieger, Claudia Simone Seefeldt, Jonas Lange, Jurgen Meyer, Michael Alfred Stroehlein, and Markus Maria Heiss have no conflicts of interest or financial ties to disclose.

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Bulian, D.R., Knuth, J., Thomaidis, P. et al. Does obesity influence the results in Transvaginal Hybrid-NOTES cholecystectomy?. Surg Endosc 32, 4632–4638 (2018). https://doi.org/10.1007/s00464-018-6216-y

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  • DOI: https://doi.org/10.1007/s00464-018-6216-y

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