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The Impact of Obesity on Perioperative Outcomes After Laparoscopic Colorectal Resection

Makino, Tomoki MD, PhD*; Shukla, Parul J. MD*; Rubino, Francesco MD; Milsom, Jeffrey W. MD*

doi: 10.1097/SLA.0b013e31823dcbf7
Reviews and Meta-Analyses

Objective: It is commonly perceived that surgery in obese patients is associated with worse outcomes than in nonobese patients. Because of the increasing prevalence of obesity and colonic diseases in the world population, the impact of obesity on outcomes of laparoscopic colectomy remains an important subject. The aim of this review was to evaluate the feasibility and safety of laparoscopic colectomy for colorectal diseases in obese patients compared with nonobese patients.

Methods: We conducted a comprehensive review for the years 1983–2010 to retrieve all relevant articles.

Results: A total of 33 studies were found to be eligible and included 3 matched case control studies and 1 review article. Obesity, often accompanied by preexisting comorbidities, was associated with longer operative times and higher rates of conversion to open procedures mainly because of the problem of exposure and difficulties in dissection. Although some studies showed obesity was associated with increased postoperative morbidity including cardiopulmonary and systemic complications, or ileus leading to longer hospital stay, there was no evidence about the negative impact of obesity on intraoperative blood loss, perioperative mortality, and reoperation rate. Whether obesity is a risk factor for wound infection after laparoscopic colectomy remains unclear. Though sometimes in obese patients, additional number of ports were necessary to successfully complete the procedure laparoscopically, obesity did not influence the number of dissected lymph nodes in cancer surgery. Lastly, the postoperative recovery of gastrointestinal function was similar between obese and nonobese patients.

Conclusions: Laparoscopic colorectal surgery appears to be a safe and reasonable option in obese patients offering the benefits of a minimally invasive approach, with no evidence for compromise in treatment of disease.

Obesity, often accompanied by co-morbidities, impacts surgical outcomes in the form of increased operative times and higher laparoscopic-to-open conversion rates; some studies also show that it increases postoperative morbidities leading to longer hospital stays. Remarkably obesity does not seem to negatively influence intra-operative blood loss, peri-operative mortality, reoperation rate, and postoperative recovery of gastrointestinal function following laparoscopic colorectal surgery.

*Section of Colon and Rectal Surgery and Division of

Metabolic Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, NY.

Reprints: Jeffrey W. Milsom, Section of Colon and Rectal Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, 1300 York Ave, NY 10065. E-mail: mim2035@med.cornell.edu

Disclosure: The authors declare that there is nothing to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.