Emergency Surgery in Obese Patients

Obesity is considered an important risk factor for the development of gastrointestinal disorders [1], likely through alterations of gastrointestinal motility. Even though gastroesophageal reflux disease is the condition mainly studied at present, the prevalence of other upper gastrointestinal symptoms has also increased. Upper gastrointestinal tract perforations occur as a result of various causes. The majority of the perforations that we see today in the esophagus are iatrogenic (about 60%), but they could be spontaneous (Boerhaave’s syndrome), traumatic or due to other causes. Perforation of a peptic, gastric or duodenal, ulcer is now less frequent because of the availability of adequate medical therapy. Peptic ulcer disease represented 1% of the discharge diagnosis of patients with a body mass index (BMI) > 25 kg/m2 admitted to the Surgical Unit of Christchurch Hospital, New Zealand in a 26-month study period [2], and a surgical intervention for perforated viscus accounted for 4.4% of patients with a BMI > 30 kg/m2 operated on at a US community teaching hospital in 1 year [3]. They represent a surgical emergency and the timing of the intervention is very important. Just one day of delay increases mortality significantly. Since a detailed discussion of upper gastrointestinal perforations is beyond the scope of this chapter, attention has been directed to examining the peculiar characteristics of this topic in the obese population.