Skip to main content
SpringerLink
Log in

Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic colorectal surgery (LCRS) has several advantages over open surgery, but LCRS has been associated with a higher rate of postoperative complications (POCs) among obese patients [body mass index (BMI), ≥30 kg/m2]. The prevalence of obesity in Chile is increasing, up to 25.1 % in 2010, suggesting that a higher percentage of patients undergoing LCRS will be obese. This study compared POC rates between obese and nonobese patients undergoing LCRS.

Methods

This study included case and control patients in a prospectively maintained LCRS database who underwent LCRS between July 2007 and June 2012 at Clinica Las Condes, Santiago, Chile. Obese and nonobese (BMI <30 kg/m2) patients were paired by gender, age, American Society of Anesthesiologists class, preoperative diagnosis, and type of surgery. Intraoperative complications and POCs were documented up to 30 days. The severity of each POC was classified by Clavien–Dindo score.

Results

In this study, 449 patients who underwent LCRS during the study period were identified. The study paired 53 obese patients (mean BMI 33.1 kg/m2) with 53 nonobese patients (mean BMI 25.9 kg/m2). The median age was 55 years in the obese group and 57 years in the nonobese group, and 60 % of the patients in both groups were men. The findings showed POCs in 13 obese (24.5 %) and 15 nonobese (28.3 %) patients (p = 0.66). Stratified by severity of POCs, the two groups were similar (p = 0.62). The two groups did not differ in terms of the median time to the first feeding (1 day each) or the hospital length of stay (4 days each). Similar percentages of patients in the two groups required reoperation (p = 0.4), intensive care unit (ICU) admission (p = 0.77), and readmission to the hospital (p = 0.65) because of POCs.

Conclusion

The frequency of POCs after LCRS was no higher among the obese patients than among the nonobese patients.

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

Access this article

Log in via an institution

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. Schwenk W, Haase O, Neudecker J, Müller JM (2005) Short-term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20:CD003145

    Google Scholar 

  2. Cirocchi R, Farinella E, Trastulli S, Sciannameo F, Audisio RA (2012) Elective sigmoid colectomy for diverticular disease: laparoscopic vs open surgery: a systematic review. Colorectal Dis 14:671–683

    Article  CAS  PubMed  Google Scholar 

  3. Bertani E, Chiappa A, Biffi R, Bianchi PP, Radice D, Branchi V, Cenderelli E, Vetrano I, Cenciarelli S, Andreoni B (2011) Assessing appropriateness for elective colorectal cancer surgery: clinical, oncological, and quality-of-life short-term outcomes employing different treatment approaches. Int J Colorectal Dis 26:1317–1327

    Article  PubMed  Google Scholar 

  4. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645

    Article  CAS  PubMed  Google Scholar 

  5. Vaid S, Tucker J, Bell T, Grim R, Ahuja V (2012) Cost analysis of laparoscopic versus open colectomy in patients with colon cancer: results from a large nationwide population database. Am Surg 78:635–641

    PubMed  Google Scholar 

  6. Orenstein SB, Elliott HL, Reines LA, Novitsky YW (2011) Advantages of the hand-assisted versus the open approach to elective colectomies. Surg Endosc 25:1364–1368

    Article  PubMed  Google Scholar 

  7. Malnick SD, Knobler H (2006) The medical complications of obesity. QJM 99:565–579

    Article  CAS  PubMed  Google Scholar 

  8. Flegal KM, Graubard BI, Williamson DF, Gail MH (2007) Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 298:2028–2037

    Article  CAS  PubMed  Google Scholar 

  9. Dindo D, Muller MK, Weber M, Clavien PA (2003) Obesity in general elective surgery. Lancet 361:2032–2035

    Article  PubMed  Google Scholar 

  10. Delaney CP, Pokala N, Senagore AJ, Casillas S, Kiran RP, Brady KM, Fazio VW (2005) Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum 48:975–981

    Article  PubMed  Google Scholar 

  11. Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237

    Article  PubMed  Google Scholar 

  12. Makino T, Shukla PJ, Rubino F, Milsom JW (2012) The impact of obesity on perioperative outcomes after laparoscopic colorectal resection. Ann Surg 255:228–236

    Article  PubMed  Google Scholar 

  13. Poulsen M, Ovesen H (2012) Is laparoscopic colorectal cancer surgery in obese patients associated with an increased risk? Short-term results from a single center study of 425 patients. J Gastrointest Surg 16:1554–1558

    Article  PubMed  Google Scholar 

  14. Health Ministry of Chile [Internet]. Santiago. http://epi.minsal.cl/wp-content/uploads/2012/07/Informe-ENS-2009-2010.-CAP-5_FINALv1julioccepi.pdf. Accessed 7 Nov 2012

  15. Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among U.S. adults, 1999–2010. JAMA 307:491–497

    Article  PubMed  Google Scholar 

  16. Doak CM, Wijnhoven TM, Schokker DF, Visscher TL, Seidell JC (2012) Age standardization in mapping adult overweight and obesity trends in the WHO European Region. Obes Rev 13:174–191

    Article  CAS  PubMed  Google Scholar 

  17. World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 854:1–452

    Google Scholar 

  18. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed Central  PubMed  Google Scholar 

  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  20. Horan TC, Culver DH, Gaynes RP, Jarvis WR, Edwards JR, Reid CR (1993) Nosocomial infections in surgical patients in the United States, January 1986–June 1992. National Nosocomial Infections Surveillance (NNIS) System. Infect Control Hosp Epidemiol 14:73–80

    Article  CAS  PubMed  Google Scholar 

  21. Scheidbach H, Benedix F, Hügel O, Kose D, Köckerling F, Lippert H (2008) Laparoscopic approach to colorectal procedures in the obese patient: risk factor or benefit? Obes Surg 18:66–70

    Article  PubMed  Google Scholar 

  22. Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53:424–429

    Article  PubMed  Google Scholar 

  23. Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–284

    Article  PubMed  Google Scholar 

  24. Longo WE, Virgo KS, Johnson FE, Oprian CA, Vernava AM, Wade TP, Phelan MA, Henderson WG, Daley J, Khuri SF (2000) Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 43:83–91

    Article  CAS  PubMed  Google Scholar 

  25. Goldberg PA, Nicholls RJ, Porter NH, Love S, Grimsey JE (1994) Long-term results of a randomised trial of short-course low-dose adjuvant preoperative radiotherapy for rectal cancer: reduction in local treatment failure. Eur J Cancer 30A:1602–1606

    Article  CAS  PubMed  Google Scholar 

  26. Marijnen CA, Kapiteijn E, van de Velde CJ, Martijn H, Steup WH, Wiggers T, Kranenbarg EK, Leer JW (2002) Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 20:817–825

    Article  CAS  PubMed  Google Scholar 

  27. Singh A, Muthukumarasamy G, Pawa N, Riaz AA, Hendricks JB, Motson RW (2011) Laparoscopic colorectal cancer surgery in obese patients. Colorectal Dis 13:878–883

    Article  CAS  PubMed  Google Scholar 

  28. Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG, Nogueras JJ, Wexner SD (2002) Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16:855–858

    Article  CAS  PubMed  Google Scholar 

  29. da Luz Moreira A, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW (2010) Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 24:1280–1286

    Article  PubMed  Google Scholar 

  30. Marks JH, Kawun UB, Hamdan W, Marks G (2008) Redefining contraindications to laparoscopic colorectal resection for high-risk patients. Surg Endosc 22:1899–1904

    Article  PubMed  Google Scholar 

  31. Balentine CJ, Marshall C, Robinson C, Wilks J, Anaya D, Albo D, Berger DH (2010) Obese patients benefit from minimally invasive colorectal cancer surgery. J Surg Res 163:29–34

    Article  PubMed  Google Scholar 

  32. Poon JT, Law WL, Chow LC, Fan JK, Lo SH (2011) Outcome of laparoscopic resection for colorectal cancer in patients with high operative risk. Ann Surg Oncol 18:1884–1890

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  34. Toma O, Suntrup P, Stefanescu A, London A, Mutch M, Kharasch E (2011) Pharmacokinetics and tissue penetration of cefoxitin in obesity: implications for risk of surgical-site infection. Anesth Analg 113:730–737

    CAS  PubMed  Google Scholar 

  35. Wick EC, Hirose K, Shore AD, Clark JM, Gearhart SL, Efron J, Makary MA (2011) Surgical-site infections and cost in obese patients undergoing colorectal surgery. Arch Surg 146:1068–1072

    Article  PubMed  Google Scholar 

  36. Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF (2004) Wound infection after elective colorectal resection. Ann Surg 239:599–607

    Article  PubMed Central  PubMed  Google Scholar 

  37. Nakamura T, Mitomi H, Ihara A, Onozato W, Sato T, Ozawa H, Hatade K, Watanabe M (2008) Risk factors for wound infection after surgery for colorectal cancer. World J Surg 32:1138–1141

    Article  PubMed  Google Scholar 

  38. Klarenbeek BR, Veenhof AA, Bergamaschi R, van der Peet DL, van den Broek WT, de Lange ES, Bemelman WA, Heres P, Lacy AM, Engel AF, Cuesta MA (2009) Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: a randomized control trial: short-term results of the Sigma Trial. Ann Surg 249:39–44

    Article  PubMed  Google Scholar 

  39. Canoy D, Luben R, Welch A, Bingham S, Wareham N, Day N, Khaw KT (2004) Abdominal obesity and respiratory function in men and women in the EPIC-Norfolk Study, United Kingdom. Am J Epidemiol 159:1140–1149

    Article  CAS  PubMed  Google Scholar 

  40. Jubber AS (2004) Respiratory complications of obesity. Int J Clin Pract 58:573–580

    Article  CAS  PubMed  Google Scholar 

  41. Brooks-Brunn JA (1997) Predictors of postoperative pulmonary complications following abdominal surgery. Chest 111:564–571

    Article  CAS  PubMed  Google Scholar 

  42. Eichenberger A, Proietti S, Wicky S, Frascarolo P, Suter M, Spahn DR, Magnusson L (2002) Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg 95:1788–1792

    Article  PubMed  Google Scholar 

  43. Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:83–91

    Article  PubMed Central  PubMed  Google Scholar 

  44. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term end points of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  45. Fernández JR, Heo M, Heymsfield SB, Pierson RN Jr, Pi-Sunyer FX, Wang ZM, Wang J, Hayes M, Allison DB, Gallagher D (2003) Is percentage body fat differentially related to body mass index in Hispanic Americans, African Americans, and European Americans? Am J Clin Nutr 77:71–75

    PubMed  Google Scholar 

  46. Tsujinaka S, Konishi F, Kawamura YJ, Saito M, Tajima N, Tanaka O, Lefor AT (2008) Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer. Dis Colon Rectum 51:1757–1767

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Rodrigo Quera for revision of the final manuscript, Daniela Simian (RN) for her help in gathering information, and Dr. Federico Aronsohn for revision of the traduced final manuscript.

Disclosures

Camila Estay, Alejandro J. Zarate, Magdalena Castro, Udo Kronberg, Francisco López-Kostner, and Claudio Wainstein have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Colorectal Unit, Surgery Department, Clinica Las Condes, Lo Fontecilla 441, 7550000, Santiago, Chile

    Camila Estay, Alejandro J. Zarate, Udo Kronberg, Francisco López-Köstner & Claudio Wainstein

  2. Research Academic Unit, Clinica Las Condes, Lo Fontecilla 441, Santiago, Chile

    Magdalena Castro

Authors
  1. Camila Estay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alejandro J. Zarate
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Magdalena Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Udo Kronberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Francisco López-Köstner
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claudio Wainstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Wainstein.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Estay, C., Zarate, A.J., Castro, M. et al. Does obesity increase early postoperative complications after laparoscopic colorectal surgery? Results from a single center. Surg Endosc 28, 2090–2096 (2014). https://doi.org/10.1007/s00464-014-3440-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3440-y

Keywords

Search

Navigation