Abstract
Background
The aim of this study was to assess the outcome of laparoscopic colorectal surgery in obese patients and compare it to that of a nonobese group of patients who underwent similar procedures.
Methods
All 162 consecutive patients who underwent an elective laparoscopic or laparoscopic-assisted segmental colorectal resection between August 1991 and December 1997 were evaluated. Body mass index (BMI; kg/m2) was used as an objective index to indicate massive obesity. The parameters analyzed included BMI, age, gender, comorbid conditions, diagnosis, procedure, American Society of Anesthesiologists classification score, operative time, estimated blood loss, transfusion requirements, intraoperative complications, conversion to laparotomy, postoperative complications, length of hospitalization, and mortality.
Results
Thirty-one patients (19.1%) were obese (23 males and 8 females). Conversion rates were significantly increased in the obese group (39 vs 13.5%, p=0.01), with an overall conversion rate of 18%. The postoperative complication rate in the obese group was 78% vs 24% in the nonobese group (p<0.01). Specifically, rates of ileus and wound infections were significantly higher in the obese group [32.3 vs 7.6% (p<0.01) and 12.9 vs 3.1%. (p=0.03), respectively]. Furthermore, hospital stay in the obese group was longer (9.5 days) than in the nonobese group (6.9 days, p=0.02).
Conclusion
Laparoscopic colorectal segmental resections are feasible in obese patients. However, increased rates of conversion to laparotomy should be anticipated and the risk of postoperative complications is significantly increased, prolonging the length of hospitalization when compared to that of nonobese patients.
Similar content being viewed by others
References
Agachan F, Joo JS, Weiss EG, Wexner SD (1996) Intraoperative laparoscopic complications. Dis Colon Rectum 39: S14-S19
Angrisoni L, Lorenzo M, De Palma G, Sivero L, Catanzano C, Tesauro B, Persico G (1995) Laparoscopic cholecystectomy in obese patients compared with nonobese patients. Surg Laparosc Endosc 5: 197–201
Bernstein MA, Dawson JW, Reissman P, Weiss EG, Nogueras JJ, Wexner SD (1996) Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy? Am Surg 62: 507–511
Bird CL, Frankl HD, Lee ER, Haile RW (1998) Obesity, weight gain, large weight changes, and adenomatous polyps of the left colon and rectum. Am J Epidemiol 147: 607–680
Bird CL, Ingles SA, Frankl HD, Lee ER, Haile RW (1996) Serum lipids and adenomas of the left colon and rectum. Cancer Epidemiol Biomarkers Prev 5: 607–612
Cohen SM, Wexner SD (1999) Laparoscopic right hemicolectomy. Surg. Rounds 17: 627–635
Davidow AL, Neugut AI, Jacobson JS, Ahsan H, Garbowski GC, Forde KA, Treat MR, Waye JD (1996) Recurrent adenomatous polyps and body mass index. Cancer Epidemiol Biomarkers Prev 5: 313–315
Fleming PP, Chan AK, Brien GO, O’sullivan GC (1997) Laparoscopic appendectomy—a successful operation in adults and children. Int J Med Sci 166: 13–15
Gadacz TR (1992) Laparoscopic cholecystectomy. In: Gadacz Cameron (ed) Current surgical therapy, 4th edn. Mosby-Year Book, St. Louis, pp 330–335
Gallup DC, Gallup DG, Nolan TE, Smith RP, Messing MF, Kline KL (1996) Use of a subcutaneous closed drainage system and antibiotics in obese gynecologic patients. Am J Obstet Gynecol 175: 358–361
Graves Jr HA, Ballinger JF, Anderson WJ (1991) Appraisal of laparoscopic cholecystectomy. Ann Surg 213: 655–662
Holz G (1989) Laparoscopy in the massively obese female. Obstet Gynecol 69: 423–424
Iroatulam AJ, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD (1998) Laparoscopic abdominoperineal resection for anorectal cancer. Am Surg 64: 12–18
Israelsson LA, Jonsson T (1997) Overweight and healing of midline incision: the importance of suture technique. Eur J Surg 163: 175–180
Jager R, Wexner SD (Eds) (1996) Laparoscopic colorectal surgery. Churchill-Livingstone, New York
Jitea N, Angelescu N, Burcos T, Cristian D, Voiculescu S, Mircea I (1996) Laparoscopic appendectomy in obese patients. A comparative study with open appendectomy. Chirurgia 45: 203–205
Katch FI, McArdle WD (1988) Nutrition, weight control and exercise. Lea & Feibinger, Philadelphia, pp 137–153
Khosla T, Lowe CR (1967) Indices of obesity derived from body weight and height. Br J Prev Soc Med 21: 122–128
Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL (1994) Increasing prevalence of overweight among US adults. J Am Mod Assoc 272: 205–211
Loffer FD, Pent D (1976) Laparoscopy in the obese patient. Am J Obstet Gynecol 125: 104–107
Mendoza D, Newman RC, Albala D, Cohen MS, Tewar A, Lingeman J (1996) Laparoscopic complications in markedly obese urologic patients (A multi-institutional review) Urology 48: 562–567
Miles RH, Carballo RE, Prinz RA, McMahon M, Pulawski G, Olen RN, Dalinghaus DL (1992) Laparoscopy: the preferred method of cholecystectomy in the morbidly obese. Surgery 112: 818–823
Neugut AI, Lee WC, Garbowski GC, Waye JD, Forde KA, Treat MR, Fenoglio-Preiser C (1991) Obesity and colorectal adenomas polyps. J Natl Cancer Inst 83: 359–361
Nicholson ML, Dennis MJS, Marshall K, Doran J, Steele RJC (1995) The influence of obesity on postoperative complications and operative difficulty in open and laparoscopic cholecystectomy. Minimally Invasive Ther 4: 19–23
Nies C, Bartsch D, Rothmund M (1994) Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications? Chirurg 65: 29–32
Phillips EH, Carrol B, Fallas MJ, Pearlstein AR (1994) Comparison of laparoscopic cholecystectomy in obese and non-obese patients. Am Surg 60: 316–321
Pitkin RM (1976) Abdominal hysterectomy in obese woman. Surg Gynecol Obst 142: 532–536
Reissman P, Cohen S, Weiss EG, Wexner SD (1996) Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 20: 277–281
Reissman P, Teoh TA, Cohen SM, Weiss EG, Nogueras JJ, Wexner SD (1995) Is early oral feeding safe after elective colorectal surgery? Ann Surg 222: 73–77
Riou JPA, Cohen JR, Johnson Jr H (1992) Factors influencing wound dehiscence. Am J Surg 163: 324–326
Roberts JV, Bates T (1992) The use of body mass index in studies of abdominal wound infection. J Hosp Infect 20: 217–220
Safran D, Sgambati S, Orlando 3rd R (1993) Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 176: 548–554
Soisson AP, Olt G, Soper JT, Berchuck A, Rodriguez G, Clarke-Pearson DL (1993) Prevention of superficial wound separation with subcutaneous retention sutures. Gynecol Oncol 51: 330–334
Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078
Surgerman HJ (1991) Surgical infections in the morbidity obese patient. Infect Med. 37–52
Teoh TA, Wexner SD (1996) Laparoscopic surgery in colorectal cancer. In: Williams N (ed) Laparoscopic colorectal surgery. Churchill-Livingstone. London, pp 103–121
Author information
Authors and Affiliations
Additional information
Online publication: 8 February 2002
Rights and permissions
About this article
Cite this article
Pikarsky, A.J., Saida, Y., Yamaguchi, T. et al. Is obesity a high-risk factor for laparoscopic colorectal surgery?. Surg Endosc 16, 855–858 (2002). https://doi.org/10.1007/s004640080069
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s004640080069