Pneumoperitoneum in the obese: Practical concerns

The laparoscopic approach to bariatric surgery was first reported in the early 1990s (1). With refinement of the laparoscopic approach to bariatric surgery, particularly laparoscopic gastric bypass, there has been a tremendous growth in the field of bariatric surgery. Patients view laparoscopic bariatric surgery as a less invasive approach and are more likely to seek laparoscopic surgical therapy for the treatment of morbid obesity. With an increase in the demand for bariatric surgery, there is also an increase in the number of surgeons interested in learning laparoscopic bariatric surgery. There has also been an increase in the number of institutions providing laparoscopic bariatric surgery workshops and growth in membership of the American Society for Bariatric Surgery. Therefore, it is important for surgeons performing laparoscopic bariatric surgery to understand the fundamental differences between laparoscopic and open surgery and possible intraoperative adverse consequences of pneumoperitoneum in the morbidly obese.