Laparoscopic Emergency Appendectomy in a Severely Obese Patient with a Body Mass Index of 56.7 kg/m²

Abstract

A severely obese 42-year-old man (height 184 cm, weight 192 kg, and body mass index (BMI) 56.7 kg/m²) presented at another clinic with abdominal pain four days earlier. He did not improve with antibiotic treatment and was referred to our department. Blood tests showed a severe inflammatory response with a white blood cell count of 10,800/μl and a C-reactive protein of 20.35 mg/dl. Abdominal computed tomography showed that the appendix was enlarged, with signs suggesting abscess formation. Localized peritonitis due to acute appendicitis was diagnosed, and laparoscopic appendectomy was performed. The patient was placed in the ramp position, and his body was immobilized with a negative-pressure postural fixation device and a fixation support device. The first port was inserted by the optical method 10 cm above the umbilicus via the left rectus abdominis. Insufflation pressure was set at 15 mmHg, and further ports were added to secure the field of view. Because the inflamed fatty appendices were difficult to distinguish from the appendix itself, rapid intraoperative diagnosis was performed to confirm that the resected tissue was the appendix. The patient's postoperative course was uneventful, and the patient was discharged improved on postoperative Day 10. Our use of laparoscopic appendectomy to treat acute appendicitis in a severely obese patient with a BMI of 56.7 kg/m² is reported.