Presurgical Assessment of Intra-abdominal Visceral Fat in Obese Patients

  • Angela Falbo
  • Stefano Palomba


To date, obesity is simply defined as body mass index (BMI) higher or equal to 30 kg/m2 (National Heart, Lung, and Blood Institute/National Institutes of Diabetes and Digestive and Kidney diseases 1998). Although BMI is widely accepted as a marker of adiposity in population-based studies, and is recognized as an instrument to diagnose obesity for all age groups, it should be more properly seen as an index of weight excess, rather than body fatness.


Obesity Attenuation Estrogen Adenocarcinoma Pneumonia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Abdominal wall fat index


Body mass index


Computed tomography


Dual-energy X-ray absorptiometry


Laparoscopy-assisted distal gastrectomy


Magnetic resonance imaging


Preperitoneal fat layer


Randomized controlled trial


Relative risk


Subcutaneous fat layer




Subcutaneous fat


Spectral attenuation with inversion recovery


3D T1-high-resolution isotropic volume examination


Visceral fat


Circumference of the waist


World Health Organization


Waist-to-hip ratio


  1. Adams JP, Murphy P. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91–108.PubMedCrossRefGoogle Scholar
  2. Alberti KG, Zimmet P, Shaw J. IDF Epidemiology Task Force Consensus Group. The metabolic syndrome–a new worldwide definition. Lancet 2005;366:1059–62.PubMedCrossRefGoogle Scholar
  3. Andreyeva T, Long MW, Brownell KD. The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food. Am J Public Health. 2010;100:216–22.PubMedCrossRefGoogle Scholar
  4. Armellini F, Zamboni M, Harris T, Micciolo R, Bosello O. Sagittal diameter minus subcutaneous thickness. An easy-to-obtain parameter that improves visceral fat prediction. Obes Res. 1997;5:315–20.PubMedGoogle Scholar
  5. Bai SW, Lim JH, Kim JY, Chung KA, Kim SK, Park KH. Relationship between obesity and the risk of gynecologic laparoscopy in Korean women. J Am Assoc Gynecol Laparosc. 2002;9:165–9.PubMedCrossRefGoogle Scholar
  6. Balkau B, Deanfield JE, Després JP, Bassand JP, Fox KA, Smith SC Jr, Barter P, Tan CE, Van Gaal L, Wittchen HU, Massien C, Haffner SM. International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Circulation. 2007;116:1942–51.PubMedCrossRefGoogle Scholar
  7. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.PubMedCrossRefGoogle Scholar
  8. Candiotti K, Sharma S, Shankar R. Obesity, obstructive sleep apnoea, and diabetes mellitus: anaesthetic implications. Br J Anaesth. 2009;103:i23–30.PubMedCrossRefGoogle Scholar
  9. Chen Y, Horne SL, Dosman JA. Body weight and weight gain related to pulmonary function decline in adults: a six year follow up study. Thorax. 1993;48:375–80.PubMedCrossRefGoogle Scholar
  10. Chen Y, Rennie D, Cormier YF, Dosman J. Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects. Am J Clin Nutr. 2007;85:35–9.PubMedGoogle Scholar
  11. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881–7.PubMedCrossRefGoogle Scholar
  12. Dobbelsteyn CJ, Joffres MR, MacLean DR, Flowerdew G. The Canadian Heart Health Surveys Research Group. comparative evaluation of waist circumference, waist-to-hip ratio and body mass index as indicators of cardiovascular risk factors. The Canadian Heart Health Surveys. Int J Obes. 2001;25:652–61.Google Scholar
  13. Eltabbakh GH, Piver MS, Hempling RE, Recio FO. Laparoscopic surgery in obese women. Obstet Gynecol. 1999;94:704–8.PubMedCrossRefGoogle Scholar
  14. Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy? Gynecol Oncol. 2000;78:329–35.PubMedCrossRefGoogle Scholar
  15. Fugita OEH, Chan DY, Roberts WW, Kavoussi LR, Jarrett TW. Laparoscopic radical nephrectomy in obese patients: outcomes and technical considerations. Urology. 2004;63:247–52.PubMedCrossRefGoogle Scholar
  16. Holub Z, Bartos P, Jabor A, Eim J, Fischlova D, Kliment L. Laparoscopic surgery in obese women with endometrial cancer. J Am Assoc Gynecol Laparosc. 2000;7:83–8.PubMedCrossRefGoogle Scholar
  17. Holub Z, Jabor A, Kliment L, Fischlova D, Wagnerova M. Eur. Laparoscopic hysterectomy in obese women: a clinical prospective study. J Obstet Gynecol Reprod Biol. 2001;98:77–82.PubMedCrossRefGoogle Scholar
  18. Kadar N. Laparoscopic pelvic lymphadenectomy in obese women with gynecologic malignancies. J Am Assoc Gynecol Laparosc. 1995;2:163–7.PubMedCrossRefGoogle Scholar
  19. Koda M, Senda M, Kamba M, Kimura K, Murawaki Y. Sonographic subcutaneous and visceral fat indices represent the distribution of body fat volume. Abdom Imaging. 2007;32:387–92.PubMedCrossRefGoogle Scholar
  20. Lamvu G, Zolnoun D, Boggess J, Steege JF. Obesity: physiologic changes and challenges during laparoscopy. Am J Obstet Gynecol. 2004;191:669–74.PubMedCrossRefGoogle Scholar
  21. Leroy J, Ananian P, Rubino F, Claudon B, Mutter D, Marescaux J. The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy. Ann Surg. 2005;241:69–76.PubMedGoogle Scholar
  22. National Heart, Lung, and Blood Institute/National Institutes of Diabetes and Digestive and Kidney diseases Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. The evidence report. Bethesda: National Institutes of Health; 1998. p. 1–228.Google Scholar
  23. Nitori N, Hasegawa H, Ishii Y, Endo T, Kitagawa Y. Impact of visceral obesity on short-term outcome after laparoscopic surgery for colorectal cancer: a single Japanese center study. Surg Laparosc Endosc Percutan Tech. 2009;19:324–7.PubMedCrossRefGoogle Scholar
  24. Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. Int J Gynecol Cancer. 2005;15:319–24.PubMedCrossRefGoogle Scholar
  25. Palomba S, Nelaj E, Zullo F. Visceral fat amount as predictive factor for early laparotomic conversion in obese patients with endometrial cancer. Gynecol Oncol. 2006;102:128–9.PubMedCrossRefGoogle Scholar
  26. Palomba S, Zupi E, Russo T, Oppedisano RM, Manguso F, Falbo A, Tolino A, Mattei A, Mastrantonio P, Zullo F. Presurgical assessment of intraabdominal visceral fat in obese patients with early-stage endometrial cancer treated with laparoscopic approach: relationships with early laparotomic conversions. J Minim Invasive Gynecol. 2007;14:195–201.PubMedCrossRefGoogle Scholar
  27. Reeves BC, Ascione R, Chamberlain MH, Angelini GD. Effect of body mass index on early outcomes in patients undergoing coronary artery bypass surgery. JACC. 2003;42:668–76.PubMedGoogle Scholar
  28. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008;371:569–78.PubMedCrossRefGoogle Scholar
  29. Schneider HJ, Glaesmer H, Klotsche J, Böhler S, Lehnert H, Zeiher AM, März W, Pittrow D, Stalla GK, Wittchen HU. DETECT Study Group. Accuracy of anthropometric indicators of obesity to predict cardiovascular risk. J Clin Endocrinol Metab. 2007;92:589–94.CrossRefGoogle Scholar
  30. Schwandner O, Farke S, Schiedeck TH, Bruch HP. Laparoscopic colorectal surgery in obese and non obese patients: do differences in body mass indices lead to different outcomes? Surg Endosc. 2004;18:1452–6.PubMedCrossRefGoogle Scholar
  31. Scribner DR Jr, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2001;84:426–30.CrossRefGoogle Scholar
  32. Sheth SS. Vaginal hysterectomy as a primary route for morbidly obese women. Acta Obstet Gynecol Scand. 2010.Google Scholar
  33. Snijder MB, Visser M, Dekker JM, Seidell JC, Fuerst T, Tylavsky F, Cauley J, Lang T, Nevitt M, Harris HB. The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly: a comparison with computed tomography and anthropometry. Int J Obes. 2002;26:984–93.CrossRefGoogle Scholar
  34. Srikanthan P, Seeman TE, Karlamangla AS. Waist-hip-ratio as a predictor of all-cause mortality in high-functioning older adults. Ann Epidemiol. 2009;19:724–31.PubMedCrossRefGoogle Scholar
  35. Suzuki R, Watanabe S, Hirai Y, Akiyama K, Nishide T, Matsushima Y, Murayama H, Ohshima H, Shinomiya M, Shirai K. Abdominal wall fat index, estimated by ultrasonography, for assessment of the ratio of visceral fat to subcutaneous fat in the abdomen. Am J Med. 1993;95:309–14.PubMedCrossRefGoogle Scholar
  36. Tantawy H. In: Hines RL, Marschall KE, editors. Stoelting’s anesthesia and co-existing disease. Philadelphia: Churchill Livingstone; 2008. p. 297–322.CrossRefGoogle Scholar
  37. Taylor AE, Ebrahim S, Ben-Shlomo Y, Martin RM, Whincup PH, Yarnell JW, Wannamethee SG, Lawlor DA. Comparison of the associations of body mass index and measures of central adiposity and fat mass with coronary heart disease, diabetes, and all-cause mortality: a study using data from 4 UK cohorts. Am J Clin Nutr. 2010;91:547–56.PubMedCrossRefGoogle Scholar
  38. Ueda J, Ichimiya H, Okido M, Kato M. The impact of visceral fat accumulation on laparoscopy-assisted distal gastrectomy for early gastric cancer. J Laparoendosc Adv Surg Tech A. 2009;19:157–62.PubMedCrossRefGoogle Scholar
  39. Wajchenberg BL. Subcutaneous and visceral adipose tissue: their relation to the metabolic syndrome. Endocr Rev. 2000;21:697–738.PubMedCrossRefGoogle Scholar
  40. Wei YF, Wu HD, Chang CY, Huang CK, Tai CM, Hung CM, Tseng WK, Wu CC. The impact of various anthropo-metric measurements of obesity on pulmonary function in candidates for surgery. Obes Surg. 2010;20:589–94.PubMedCrossRefGoogle Scholar
  41. World Health Organization. Obesity: Preventing and managing the global epidemic: Report on a WHO consultation (WHO Technical Report Series 894). Geneva, Switzerland: World Health Organization; 2000.Google Scholar
  42. Yanovski SZ. A practical approach to treatment of the obese patient. Arch Fam Med. 1993;2:309–16.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Unit of Reproductive Medicine and Surgery, Department of Gynecology & ObstetricsUniversity “Magna Graecia” of CatanzaroCatanzaroItaly

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