Skip to main content
Log in

Is obesity a high-risk factor for laparoscopic colorectal surgery?

  • Original Articles
  • Published:
Surgical Endoscopy and Other Interventional Techniques Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Agachan F, Joo JS, Weiss EG, Wexner SD (1996) Intraoperative laparoscopic complications. Dis Colon Rectum 39: S14-S19

    Article  PubMed  CAS  Google Scholar 

  2. 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

    Google Scholar 

  3. 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

    PubMed  CAS  Google Scholar 

  4. 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

    Google Scholar 

  5. 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

    PubMed  CAS  Google Scholar 

  6. Cohen SM, Wexner SD (1999) Laparoscopic right hemicolectomy. Surg. Rounds 17: 627–635

    Google Scholar 

  7. 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

    PubMed  CAS  Google Scholar 

  8. 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

    Article  CAS  Google Scholar 

  9. Gadacz TR (1992) Laparoscopic cholecystectomy. In: Gadacz Cameron (ed) Current surgical therapy, 4th edn. Mosby-Year Book, St. Louis, pp 330–335

    Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. Graves Jr HA, Ballinger JF, Anderson WJ (1991) Appraisal of laparoscopic cholecystectomy. Ann Surg 213: 655–662

    Article  PubMed  Google Scholar 

  12. Holz G (1989) Laparoscopy in the massively obese female. Obstet Gynecol 69: 423–424

    Google Scholar 

  13. Iroatulam AJ, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD (1998) Laparoscopic abdominoperineal resection for anorectal cancer. Am Surg 64: 12–18

    PubMed  CAS  Google Scholar 

  14. Israelsson LA, Jonsson T (1997) Overweight and healing of midline incision: the importance of suture technique. Eur J Surg 163: 175–180

    PubMed  CAS  Google Scholar 

  15. Jager R, Wexner SD (Eds) (1996) Laparoscopic colorectal surgery. Churchill-Livingstone, New York

    Google Scholar 

  16. 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

    PubMed  CAS  Google Scholar 

  17. Katch FI, McArdle WD (1988) Nutrition, weight control and exercise. Lea & Feibinger, Philadelphia, pp 137–153

    Google Scholar 

  18. Khosla T, Lowe CR (1967) Indices of obesity derived from body weight and height. Br J Prev Soc Med 21: 122–128

    PubMed  CAS  Google Scholar 

  19. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL (1994) Increasing prevalence of overweight among US adults. J Am Mod Assoc 272: 205–211

    Article  CAS  Google Scholar 

  20. Loffer FD, Pent D (1976) Laparoscopy in the obese patient. Am J Obstet Gynecol 125: 104–107

    PubMed  CAS  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    PubMed  CAS  Google Scholar 

  23. 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

    Article  PubMed  CAS  Google Scholar 

  24. 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

    Article  Google Scholar 

  25. Nies C, Bartsch D, Rothmund M (1994) Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications? Chirurg 65: 29–32

    PubMed  CAS  Google Scholar 

  26. Phillips EH, Carrol B, Fallas MJ, Pearlstein AR (1994) Comparison of laparoscopic cholecystectomy in obese and non-obese patients. Am Surg 60: 316–321

    PubMed  CAS  Google Scholar 

  27. Pitkin RM (1976) Abdominal hysterectomy in obese woman. Surg Gynecol Obst 142: 532–536

    CAS  Google Scholar 

  28. Reissman P, Cohen S, Weiss EG, Wexner SD (1996) Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 20: 277–281

    Article  PubMed  CAS  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. Riou JPA, Cohen JR, Johnson Jr H (1992) Factors influencing wound dehiscence. Am J Surg 163: 324–326

    Article  PubMed  CAS  Google Scholar 

  31. Roberts JV, Bates T (1992) The use of body mass index in studies of abdominal wound infection. J Hosp Infect 20: 217–220

    Article  PubMed  CAS  Google Scholar 

  32. Safran D, Sgambati S, Orlando 3rd R (1993) Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 176: 548–554

    PubMed  CAS  Google Scholar 

  33. 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

    Article  PubMed  CAS  Google Scholar 

  34. Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078

    Google Scholar 

  35. Surgerman HJ (1991) Surgical infections in the morbidity obese patient. Infect Med. 37–52

  36. Teoh TA, Wexner SD (1996) Laparoscopic surgery in colorectal cancer. In: Williams N (ed) Laparoscopic colorectal surgery. Churchill-Livingstone. London, pp 103–121

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Online publication: 8 February 2002

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s004640080069

Key words

Navigation