Complications of Laparoscopic Surgery Vs. Open Surgery In Obese Patients


Laparoscopic surgery is an advancement in conventional surgical techniques. This technique is used for surgeries of the abdominal cavity and pelvis. It is performed for diagnostic as well as therapeutic purposes. 

In laparoscopic surgery, there is no need to open the abdominal cavity. The surgeon inserts a long instrument (laparoscope) through small incisions. The incision length ranges from 8mm to 19 mm. That is why this is also known as keyhole surgery (Peri et al., 2021) (McKay and Blake, 2006) 

Almost every surgical procedure is associated with some complications. These can be classified as intraoperative (during the procedure) and postoperative (after surgical procedure). In this article, we will discuss complications of laparoscopic surgery vs. open surgery in obese patients. 

This minimally invasive surgical technique has far fewer complications as compared to open surgeries. We will compare the complications of both techniques in different surgical procedures. 

1. Laparoscopic vs. open appendectomy in obese patients: 

a. Appendectomy is one of the most commonly performed surgical procedures. A review article published in the international journal of surgery showed the superiority of laparoscopic appendectomy over open appendectomy (Markar et al., 2011). Two thousand three hundred nine appendectomies were compared in this study. 1187 were open appendectomies, and 1187 were laparoscopic. The analysis showed a shorter stay in the hospital after laparoscopic appendectomy. There was no significant difference in wound infection or other postoperative complications. (Markar et al., 2011) 

b. Another meta-analysis was published in the “Journal of minimal access surgery.” This analysis showed a lower wound infection rate and other postoperative complications in laparoscopic surgery than open surgery. All of the operated patients were obese and had a BMI of more than 30. (Ciarrocchi and Amicucci, 2014) 

c. Another study published in SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) journal analyzed complications of appendectomy in 

morbidly obese (BMI more than 40) patients. Out of a total of 1976 patients, laparoscopic appendectomy was performed in 83.1% of patients. This group had a lower rate of pulmonary and surgical wound complications. However, there was no difference in overall mortality. 

2. Laparoscopic vs. open surgery for rectal cancer in obese patients: 

a. A study published in 2016 analyzed clinical data of 268 patients who underwent surgery for rectal cancer. The study showed no significant difference in rates of complications and operative times between the two groups (laparoscopic and open). However, the blood loss was much lower in the laparoscopic group than in the open group. (Matsuzaki et al., 2017). 

b. An article published in 2018 analyzed the effects of increasing BMI on laparoscopic surgery for colorectal cancers. The two objectives of this study were to check the clinical outcome and conversion rate to open surgery, i.e., laparotomy. This article showed that obesity increases the rates of surgical complications such as wound complications and leakage of anastomoses. Recurrence of tumor and mortality rate were not affected by elevated BMI. The conversion rate to open surgery for colon cancer was 4.1 times more in obese patients. (Bell et al., 2018) 

c. Another study was published in “Journal of Laparoendoscopic & Advanced Surgical Techniques” in 2011 to assess the safety of laparoscopic vs. open resection of rectal cancer. The laparoscopic procedure was associated with an earlier time of first discharge, (Matsuzaki et al., 2017, McKay and Blake, 2006, Peri et al., 2021) resumption of bowel movement and food intake. However, there were no significant differences in overall mortality rates (Liang et al., 2011) 

3. Laparoscopic vs. open umbilical hernia repair in obese patients: 

a. A review article published in 2013 in “The American Journal of Surgery.” This study aimed to determine which surgical option had a better outcome. 123 obese (BMI more than 30) patients with umbilical hernias were included in the study. Forty-three patients were operated on by laparoscopic approach, and 80 were operated by open technique. 

No complications were reported during procedures. There was no recurrence of hernia in patients operated by laparoscopic technique. The postoperative wound infection rate was much higher in open umbilical hernia repair. 

b. A systemic review with meta-analysis was published in 2017. A total of 16,549 patients were analyzed. The analysis results showed decreased percentages of wound infection, wound dehiscence and recurrence rates in 

laparoscopic repair compared to open repair. However, the intraoperative time was longer for laparoscopic repair (Bell et al., 2018) 


This article has discussed the outcomes and complications associated with laparoscopic vs. open surgical techniques in obese patients. We chose appendectomy, surgeries for colorectal cancer resection and repair of ventral hernia. Most of the studies suggest that complications associated with the laparoscopic approach are lesser than those associated with the open technique. Only con of the laparoscopic approach was more intraoperative time. Therefore, the laparoscopic approach is more effective and safer than open surgeries in obese patients. 


BELL, S., KONG, J., WALE, R., STAPLES, M., OLIVA, K., WILKINS, S., MC MURRICK, P. & WARRIER, S. 2018. The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Disease, 20, 778-788. 

CIARROCCHI, A. & AMICUCCI, G. 2014. Laparoscopic versus open appendectomy in obese patients: A meta-analysis of prospective and retrospective studies. Journal of minimal access surgery, 10, 4. 

LIANG, X., HOU, S., LIU, H., LI, Y., JIANG, B., BAI, W., LI, G., WANG, W., FENG, Y. & GUO, J. 2011. Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China. Journal of laparoendoscopic & advanced surgical techniques, 21, 381-385. 

MARKAR, S. R., VENKAT-RAMAN, V., HO, A., KARTHIKESALINGAM, A., KINROSS, J., EVANS, J. & BLOOM, I. 2011. Laparoscopic versus open appendicectomy in obese patients. International Journal of Surgery, 9, 451-455. 

MATSUZAKI, H., ISHIHARA, S., KAWAI, K., MURONO, K., OTANI, K., YASUDA, K., NISHIKAWA, T., TANAKA, T., KIYOMATSU, T. & HATA, K. 2017. Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study. Surgery today, 47, 627-635. 

MCKAY, D. & BLAKE, G. 2006. Optimum incision length for port insertion in laparoscopic surgery. The Annals of The Royal College of Surgeons of England, 88, 78-78. 

PERI, A., GREENSTEIN, E., ALON, M., PAI, J. A., DINGJAN, T., REICH-ZELIGER, S., BARNEA, E., BARBOLIN, C., LEVY, R. & ARNEDO-PAC, C. 2021. Combined presentation and immunogenicity analysis reveals a recurrent RAS. Q61K neoantigen in melanoma. The Journal of Clinical Investigation, 131.