Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis.

INTRODUCTION: Lumbar disc herniation in obese individuals poses unique surgical challenges which can influence outcomes in such patients. Limited studies are available evaluating the results of discectomy in obese persons. The aim of this review was to compare outcomes in obese and non-obese individuals; and to analyse whether approach to surgery had a bearing on these outcomes. METHODS: The literature search was conducted on four databases (PubMed, Medline, EMBASE, and CINAHL) and PRISMA guidelines were followed. After screening by the authors, eight studies were shortlisted from which data were extracted and analysed. Comparative analysis was done for lumbar discectomy (microdiscectomy or minimally invasive vs. endoscopic technique) between obese and non-obese groups from the six comparative studies in our review. Pooled estimates and subgroup analysis was done to ascertain the effect of surgical approach on outcomes. RESULTS: Eight studies published between 2007 and 2021 were included. Mean age of study cohort was 39.05 years. Mean operative time was significantly shorter in the non-obese group mean difference of 15.1 min (95% CI - 0.24 to 30.5). On subgroup analysis, obese individuals operated via endoscopic approach had significantly decreased operative time as compared to open approach. Blood loss and complication rates were also lower in the non-obese groups, but not statistically significant. CONCLUSION: Significantly less mean operative time was seen in non-obese individuals and when obese patients were operated via endoscopic approach. This difference between obese and non-obese groups was significantly more in the open subgroup as compared to the endoscopic subgroup. No significant differences in blood loss, mean improvement in VAS score, recurrence rate, complication rate and length of hospital stay was found between obese and non-obese patients as well as between endoscopic versus open lumbar discectomy within the obese subgroup. The learning curve associated with endoscopy makes it a challenging procedure.