Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Laparoscopic surgery benefits obese patients but technical difficulties associated with suboptimal exposure and access in these subjects may prompt conversion to open surgery. Hand-assisted laparoscopic surgery (HALS) confers advantages over standard laparoscopy (LAP) by facilitating tactile feedback, assisted dissection, and retraction. These benefits could be particularly valuable in obese patients, allowing completion of difficult laparoscopic procedures in this subgroup. Our aim was to compare intra-operative and post-operative outcomes of HALS and LAP approaches in obese patients undergoing colorectal resection at our institution.

Methods

A retrospective study of a prospectively maintained laparoscopic colorectal surgery database was performed. HALS and LAP cases performed in obese patients (body mass index (BMI) >30) were identified and compared for the following outcomes: operative time, intra-operative complications, rate of conversion to open, blood loss, length of stay, post-operative morbidity, and mortality. Outcomes for the converted patients were included on an intention-to-treat basis for all primary analyses. A secondary analysis of nonconverted and converted cases was also performed.

Results

Over a 5-year period, 496 obese patients underwent laparoscopic colorectal resection; 86 HALS and 410 LAP cases. The two groups were comparable in terms of age, gender, BMI, and indications for surgery. Conversion to open surgery was less often necessary in HALS compared to LAP cases (3.5 % vs. 12.7 %, p = 0.014). The LAP group had a significantly smaller incision length for specimen extraction (HALS (7.0 ± 1.3 cm) vs. LAP (5.7 ± 2.1 cm), p < 0.001). Length of stay, operative time, morbidity, and mortality rates were comparable between the two groups.

Conclusion

In obese patients who require colectomy, the HALS approach increases the likelihood of a successful minimally invasive operation. At the cost of a clinically negligible increase in incision length, HALS may save a high-risk group conversion to formal laparotomy and the adverse outcomes related to this.

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. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303(3):235–41.

    Article  PubMed  CAS  Google Scholar 

  2. Field AE, Coakley EH, Must A, et al. Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Arch Intern Med 2001; 161(13):1581–6.

    Article  PubMed  CAS  Google Scholar 

  3. Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999; 282(16):1523–9.

    Article  PubMed  CAS  Google Scholar 

  4. Pasulka PS, Bistrian BR, Benotti PN, et al. The risks of surgery in obese patients. Ann Intern Med 1986; 104(4):540–6.

    PubMed  CAS  Google Scholar 

  5. The Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350(20):2050–9.

    Article  Google Scholar 

  6. Guillou PJ, Quirke P, Thorpe H, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 2005; 365(9472):1718–26.

    Article  PubMed  Google Scholar 

  7. Hazebroek EJ. COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 2002; 16(6):949–53.

    Article  PubMed  CAS  Google Scholar 

  8. Hewett PJ, Allardyce RA, Bagshaw PF, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg 2008; 248(5):728–38.

    Article  PubMed  Google Scholar 

  9. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 2002; 359(9325):2224–9.

    Article  PubMed  Google Scholar 

  10. Buunen M, Veldkamp R, Hop WC, et al. Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 2009; 10(1):44–52.

    Article  PubMed  Google Scholar 

  11. Jayne DG, Thorpe HC, Copeland J, et al. Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 2010; 97(11):1638–45.

    Article  PubMed  CAS  Google Scholar 

  12. Ballian N, Yamane B, Leverson G, et al. Body mass index does not affect postoperative morbidity and oncologic outcomes of total mesorectal excision for rectal adenocarcinoma. Ann Surg Oncol 2010; 17(6):1606–13.

    Article  PubMed  Google Scholar 

  13. Delaney CP, Pokala N, Senagore AJ, et al. Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy. Dis Colon Rectum 2005; 48(5):975–81.

    Article  PubMed  Google Scholar 

  14. Healy LA, Ryan AM, Sutton E, et al. Impact of obesity on surgical and oncological outcomes in the management of colorectal cancer. Int J Colorectal Dis 2010; 25(11):1293–9.

    Article  PubMed  Google Scholar 

  15. Khoury W, Stocchi L, Geisler D. Outcomes after laparoscopic intestinal resection in obese versus non-obese patients. Br J Surg 2011; 98(2):293–8.

    Article  PubMed  CAS  Google Scholar 

  16. Park JW, Lim SW, Choi HS, et al. The impact of obesity on outcomes of laparoscopic surgery for colorectal cancer in Asians. Surg Endosc 2010; 24(7):1679–85.

    Article  PubMed  Google Scholar 

  17. Scheidbach H, Benedix F, Hugel O, et al. Laparoscopic approach to colorectal procedures in the obese patient: risk factor or benefit? Obes Surg 2008; 18(1):66–70.

    Article  PubMed  Google Scholar 

  18. Schwandner O, Farke S, Schiedeck TH, et al. Laparoscopic colorectal surgery in obese and nonobese patients: do differences in body mass indices lead to different outcomes? Surg Endosc 2004; 18(10):1452–6.

    Article  PubMed  CAS  Google Scholar 

  19. Ozturk E, da Luz Moreira A, Vogel JD. Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Colorectal Dis 2010; 12(10 Online):e304-9.

    Article  Google Scholar 

  20. Sonoda T, Pandey S, Trencheva K, et al. Longterm complications of hand-assisted versus laparoscopic colectomy. J Am Coll Surg 2009; 208(1):62–6.

    Article  PubMed  Google Scholar 

  21. Vogel JD, Lian L, Kalady MF, et al. Hand-assisted laparoscopic right colectomy: how does it compare to conventional laparoscopy? J Am Coll Surg 2011; 212(3):367–72.

    Article  PubMed  Google Scholar 

  22. Yun HR, Cho YK, Cho YB, et al. Comparison and short-term outcomes between hand-assisted laparoscopic surgery and conventional laparoscopic surgery for anterior resections of left-sided colon cancer. Int J Colorectal Dis 2010; 25(8):975–81.

    Article  PubMed  Google Scholar 

  23. Cima RR, Pendlimari R, Holubar SD, et al. Utility and short-term outcomes of hand-assisted laparoscopic colorectal surgery: a single-institution experience in 1103 patients. Dis Colon Rectum 2011; 54(9):1076–81.

    Article  PubMed  Google Scholar 

  24. Moloo H, Haggar F, Coyle D, et al. Hand assisted laparoscopic surgery versus conventional laparoscopy for colorectal surgery. Cochrane Database Syst Rev 2010(10):CD006585.

    PubMed  Google Scholar 

  25. Pendlimari R, Holubar SD, Pattan-Arun J, et al. Hand-assisted laparoscopic colon and rectal cancer surgery: feasibility, short-term, and oncological outcomes. Surgery 2010; 148(2):378–85.

    Article  PubMed  Google Scholar 

  26. Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Am J Surg 2005; 189(4):395–404.

    Article  PubMed  Google Scholar 

  27. Holubar SD, Dozois EJ, Privitera A, et al. Minimally invasive colectomy for Crohn's colitis: a single institution experience. Inflamm Bowel Dis 2010; 16(11):1940–6.

    Article  PubMed  Google Scholar 

  28. Pendlimari R, Touzios JG, Azodo IA, et al. Short-term outcomes after elective minimally invasive colectomy for diverticulitis. Br J Surg 2011; 98(3):431–5.

    Article  PubMed  CAS  Google Scholar 

  29. El-Gazzaz G, Geisler D, Hull T. Risk of clinical leak after laparoscopic versus open bowel anastomosis. Surg Endosc 2010; 24(8):1898–903.

    Article  PubMed  Google Scholar 

  30. Ozturk E, Kiran RP, Geisler DP, et al. Hand-assisted laparoscopic colectomy: benefits of laparoscopic colectomy at no extra cost. J Am Coll Surg 2009; 209(2):242–7.

    Article  PubMed  Google Scholar 

  31. Aalbers AG, Doeksen A, Van Berge Henegouwen MI, Bemelman WA. Hand-assisted laparoscopic versus open approach in colorectal surgery: a systematic review. Colorectal Dis 2010; 12(4):287–95.

    Article  PubMed  CAS  Google Scholar 

  32. Li JC, Lee JF, Ng SS, et al. Conversion in laparoscopic-assisted colectomy for right colon cancer: risk factors and clinical outcomes. Int J Colorectal Dis 2010; 25(8):983–8.

    Article  PubMed  Google Scholar 

  33. HALS Study Group. Hand-assisted laparoscopic surgery vs standard laparoscopic surgery for colorectal disease: a prospective randomized trial. Surg Endosc 2000; 14(10):896–901.

    Article  Google Scholar 

  34. Marcello PW, Fleshman JW, Milsom JW, et al. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 2008; 51(6):818–26; discussion 826–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Helen M. Heneghan, Sean T. Martin, Ravi P. Kiran, Wisam Khoury, Luca Stocchi, Feza H. Remzi & Jon D. Vogel

Authors
  1. Helen M. Heneghan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean T. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ravi P. Kiran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wisam Khoury
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Stocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Feza H. Remzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jon D. Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jon D. Vogel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heneghan, H.M., Martin, S.T., Kiran, R.P. et al. Laparoscopic Colorectal Surgery for Obese Patients: Decreased Conversions with the Hand-Assisted Technique. J Gastrointest Surg 17, 548–554 (2013). https://doi.org/10.1007/s11605-012-2089-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-2089-x

Keywords

Search

Navigation