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

  • A. J. Pikarsky
  • Y. Saida
  • T. Yamaguchi
  • S. Martinez
  • W. Chen
  • E. G. Weiss
  • J. J. Nogueras
  • S. D. Wexner
Original Articles



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.


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.


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).


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.

Key words

Laparoscopy Laparoscopic surgery Colorectal surgery Obesity Colectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Agachan F, Joo JS, Weiss EG, Wexner SD (1996) Intraoperative laparoscopic complications. Dis Colon Rectum 39: S14-S19PubMedCrossRefGoogle Scholar
  2. 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: 197–201Google Scholar
  3. 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: 507–511PubMedGoogle Scholar
  4. 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: 607–680Google Scholar
  5. 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: 607–612PubMedGoogle Scholar
  6. 6.
    Cohen SM, Wexner SD (1999) Laparoscopic right hemicolectomy. Surg. Rounds 17: 627–635Google Scholar
  7. 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: 313–315PubMedGoogle Scholar
  8. 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: 13–15CrossRefGoogle Scholar
  9. 9.
    Gadacz TR (1992) Laparoscopic cholecystectomy. In: Gadacz Cameron (ed) Current surgical therapy, 4th edn. Mosby-Year Book, St. Louis, pp 330–335Google Scholar
  10. 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: 358–361PubMedCrossRefGoogle Scholar
  11. 11.
    Graves Jr HA, Ballinger JF, Anderson WJ (1991) Appraisal of laparoscopic cholecystectomy. Ann Surg 213: 655–662PubMedCrossRefGoogle Scholar
  12. 12.
    Holz G (1989) Laparoscopy in the massively obese female. Obstet Gynecol 69: 423–424Google Scholar
  13. 13.
    Iroatulam AJ, Agachan F, Alabaz O, Weiss EG, Nogueras JJ, Wexner SD (1998) Laparoscopic abdominoperineal resection for anorectal cancer. Am Surg 64: 12–18PubMedGoogle Scholar
  14. 14.
    Israelsson LA, Jonsson T (1997) Overweight and healing of midline incision: the importance of suture technique. Eur J Surg 163: 175–180PubMedGoogle Scholar
  15. 15.
    Jager R, Wexner SD (Eds) (1996) Laparoscopic colorectal surgery. Churchill-Livingstone, New YorkGoogle Scholar
  16. 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: 203–205PubMedGoogle Scholar
  17. 17.
    Katch FI, McArdle WD (1988) Nutrition, weight control and exercise. Lea & Feibinger, Philadelphia, pp 137–153Google Scholar
  18. 18.
    Khosla T, Lowe CR (1967) Indices of obesity derived from body weight and height. Br J Prev Soc Med 21: 122–128PubMedGoogle Scholar
  19. 19.
    Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL (1994) Increasing prevalence of overweight among US adults. J Am Mod Assoc 272: 205–211CrossRefGoogle Scholar
  20. 20.
    Loffer FD, Pent D (1976) Laparoscopy in the obese patient. Am J Obstet Gynecol 125: 104–107PubMedGoogle Scholar
  21. 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: 562–567PubMedCrossRefGoogle Scholar
  22. 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: 818–823PubMedGoogle Scholar
  23. 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: 359–361PubMedCrossRefGoogle Scholar
  24. 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: 19–23CrossRefGoogle Scholar
  25. 25.
    Nies C, Bartsch D, Rothmund M (1994) Laparoscopic cholecystectomy in morbid obesity. Indications or contraindications? Chirurg 65: 29–32PubMedGoogle Scholar
  26. 26.
    Phillips EH, Carrol B, Fallas MJ, Pearlstein AR (1994) Comparison of laparoscopic cholecystectomy in obese and non-obese patients. Am Surg 60: 316–321PubMedGoogle Scholar
  27. 27.
    Pitkin RM (1976) Abdominal hysterectomy in obese woman. Surg Gynecol Obst 142: 532–536Google Scholar
  28. 28.
    Reissman P, Cohen S, Weiss EG, Wexner SD (1996) Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 20: 277–281PubMedCrossRefGoogle Scholar
  29. 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: 73–77PubMedCrossRefGoogle Scholar
  30. 30.
    Riou JPA, Cohen JR, Johnson Jr H (1992) Factors influencing wound dehiscence. Am J Surg 163: 324–326PubMedCrossRefGoogle Scholar
  31. 31.
    Roberts JV, Bates T (1992) The use of body mass index in studies of abdominal wound infection. J Hosp Infect 20: 217–220PubMedCrossRefGoogle Scholar
  32. 32.
    Safran D, Sgambati S, Orlando 3rd R (1993) Laparoscopy in high-risk cardiac patients. Surg Gynecol Obstet 176: 548–554PubMedGoogle Scholar
  33. 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: 330–334PubMedCrossRefGoogle Scholar
  34. 34.
    Southern Surgeons Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078Google Scholar
  35. 35.
    Surgerman HJ (1991) Surgical infections in the morbidity obese patient. Infect Med. 37–52Google Scholar
  36. 36.
    Teoh TA, Wexner SD (1996) Laparoscopic surgery in colorectal cancer. In: Williams N (ed) Laparoscopic colorectal surgery. Churchill-Livingstone. London, pp 103–121Google Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • A. J. Pikarsky
    • 1
  • Y. Saida
    • 1
  • T. Yamaguchi
    • 1
  • S. Martinez
    • 1
  • W. Chen
    • 1
  • E. G. Weiss
    • 1
  • J. J. Nogueras
    • 1
  • S. D. Wexner
    • 1
  1. 1.Department of Colorectal SurgeryCleveland Clinic FloridaWestonUSA

Personalised recommendations