PURPOSE
The benefits of early postoperative recovery, reduced postoperative pain, pulmonary dysfunction, and hospitalization after laparoscopic colectomy may improve outcome over open colectomy in obese patients. This case-matched study compares outcomes after open and laparoscopic colectomy.
METHODS
A total of 94 laparoscopic colectomy patients with a body mass index >30 (Jan 1999–June 2003) were identified from a prospective database and matched to open colectomy cases for age, gender, body mass index, American Society of Anesthesiologists class, procedure, indication, and date of surgery. Operating time, length of stay, conversion, intraoperative and postoperative complications, reoperation, 30-day readmission rate, and costs were compared. Data are presented as means ± standard deviations, and appropriate statistical tests were used.
RESULTS
The two groups were matched for age (P = 0.06), gender (P = 1), American Society of Anesthesiologists class (P = 0.2), body mass index (P = 0.4), indication for surgery (P = 1), and procedure (P = 1). By using intention-to-treat–type analysis, there was no difference in median operating time (100 vs. 110 (mean, 123 vs. 112) minutes; P = 0.1), complications (21 vs. 24 percent; P = 0.74), readmission (17 vs. 10.6 percent; P = 0.3), reoperation rates (6.4 vs. 4.3 percent; P = 0.75), or direct costs (median, $3,368 vs. $3,552; mean, $4,003 vs. $4,037; P = 0.14) between laparoscopic colectomy or open colectomy; however, the median length of stay (3 vs. 5.5 (mean, 3.8 vs. 5.8) days; P = 0.0001) was significantly shorter after laparoscopic colectomy. Twenty-eight patients required conversion for adhesions (n = 11), bleeding (n = 3), obesity-hindering vision or dissection (n = 9), large phlegmon or tumor (n = 4), and ureteric injury (n = 1). The mean operating time for conversions was 142 minutes and length of stay was 6.4 days. Compared with laparoscopically completed cases, the median length of stay (5 vs. 2 (mean, 6.4 vs. 2.8) days; P = 0.0001) and median operating times (150 vs. 95 (mean, 142 vs. 115) minutes; P = 0.02) were significantly higher in the converted group, but there was no difference in the complication (P = 0.8), readmission (P = 1), or reoperation (P = 0.7) rates. Compared with open colectomy, the operating time (P = 0.02) was significantly higher in the converted group but there were no significant differences in the length of stay (P = 0.18), complication (P = 1), readmission (P = 0.35), or reoperative (P = 1) rates.
CONCLUSIONS
Laparoscopic colectomy can be performed safely in obese patients, with shorter postoperative recovery than that with open colectomy. Although obesity is associated with a high conversion rate, outcome in these converted cases is comparable to the matched open cases.
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REFERENCES
KM Flegal MD Carroll CL Ogden CL Johnson (2002) ArticleTitlePrevalence and trends in obesity among US adults, 1999–2000 JAMA 288 1723–7 Occurrence Handle10.1001/jama.288.14.1723 Occurrence Handle12365955
TH Blee GE Belzer PJ Lambert (2002) ArticleTitleObesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma? Am Surg 68 163–6 Occurrence Handle11842964
PS Choban L Flancbaum (1997) ArticleTitleThe impact of obesity on surgical outcomes: a review J Am Coll Surg 185 593–603 Occurrence Handle1:STN:280:DyaK1c%2Fmsleqsg%3D%3D Occurrence Handle9404886
JS Garrow EJ Hastings AG Cox et al. (1988) ArticleTitleObesity and postoperative complications of abdominal operation BMJ 297 181 Occurrence Handle1:STN:280:DyaL1czhtVansg%3D%3D Occurrence Handle3408957 Occurrence Handle10.1136/bmj.297.6642.181
LA Israelsson T Jonsson (1997) ArticleTitleOverweight and healing of midline incisions: the importance of suture technique Eur J Surg 163 175–80 Occurrence Handle1:STN:280:DyaK2s3jvFeqtA%3D%3D Occurrence Handle9085058
B Bohm JW Milsom VW Fazio (1995) ArticleTitlePostoperative intestinal motility following conventional and laparoscopic intestinal surgery Arch Surg 130 415–9 Occurrence Handle1:STN:280:DyaK2M3isFOgsA%3D%3D Occurrence Handle7710343
M Braga A Vignali W Zuliani et al. (2002) ArticleTitleMetabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial Dis Colon Rectum 45 1070–7 Occurrence Handle12195192
HH Chen AJ Iroatulam O Alabaz et al. (1999) ArticleTitleLaparoscopic colectomy is superior to laparotomy for reduction of disability in patients with colorectal adenoma Changgeng Yi Xue Za Zhi 22 586–92 Occurrence Handle1:STN:280:DC%2BD3c7lvFGhug%3D%3D Occurrence Handle10695205
CP Delaney RP Kiran AJ Senagore K Brady VW Fazio (2003) ArticleTitleCase-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery Ann Surg 238 67–72 Occurrence Handle12832967
W Schwenk B Bohm JM Muller (1998) ArticleTitlePostoperative pain and fatigue after laparoscopic or conventional colorectal resections. A prospective randomized trial Surg Endosc 12 1131–6 Occurrence Handle1:STN:280:DyaK1czosVClsg%3D%3D Occurrence Handle9716766
W Schwenk B Bohm C Witt T Junghans K Grundel JM Muller (1999) ArticleTitlePulmonary function following laparoscopic or conventional colorectal resection: a randomized controlled evaluation Arch Surg 134 6–13 Occurrence Handle1:STN:280:DyaK1M7isVeisA%3D%3D Occurrence Handle9927122
AJ Senagore HJ Duepree CP Delaney KM Brady VW Fazio (2003) ArticleTitleResults of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience Dis Colon Rectum 46 503–9 Occurrence Handle12682545
MJ Solomon CJ Young AA Eyers RA Roberts (2002) ArticleTitleRandomized clinical trial of laparoscopic versus open abdominal rectopexy for rectal prolapse Br J Surg 89 35–9 Occurrence Handle1:STN:280:DC%2BD387hvVCntg%3D%3D Occurrence Handle11851660
AJ Pikarsky Y Saida T Yamaguchi et al. (2002) ArticleTitleIs obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc 16 855–8 Occurrence Handle1:STN:280:DC%2BD383lvVagsA%3D%3D Occurrence Handle11997837
AJ Senagore CP Delaney K Madboulay KM Brady VW Fazio (2003) ArticleTitleLaparoscopic colectomy in obese and nonobese patients J Gastrointest Surg 7 558–61 Occurrence Handle12763416
JJ Tuech N Regenet S Hennekinne P Pessaux R Bergamaschi JP Arnaud (2001) ArticleTitleLaparoscopic colectomy for sigmoid diverticulitis in obese and nonobese patients: a prospective comparative study Surg Endosc 15 1427–30 Occurrence Handle1:STN:280:DC%2BD383ivVSktw%3D%3D Occurrence Handle11965459
H Hasegawa M Watanabe H Baba H Nishibori M Kitajima (2002) ArticleTitleLaparoscopic restorative proctocolectomy for patients with ulcerative colitis J Laparoendosc Adv Surg Tech A 12 403–6 Occurrence Handle12590719
YH Ho M Tan KW Eu A Leong FS Choen (1997) ArticleTitleLaparoscopic-assisted compared with open total colectomy in treating slow transit constipation ANZ J Surg 67 562–5 Occurrence Handle1:STN:280:DyaK2svjsVSnsg%3D%3D
F Kockerling C Schneider MA Reymond et al. (1999) ArticleTitleLaparoscopic resection of sigmoid diverticulitis. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group Surg Endosc 13 567–71 Occurrence Handle1:STN:280:DyaK1M3nvVGgug%3D%3D Occurrence Handle10347292
DM Lawrence MD Pasquale TE Wasser (2003) ArticleTitleLaparoscopic versus open sigmoid colectomy for diverticulitis Am Surg 69 499–504 Occurrence Handle12852507
KM Madbouly AJ Senagore CP Delaney HJ Duepree KM Brady VW Fazio (2003) ArticleTitleClinically based management of rectal prolapse Surg Endosc 17 99–103 Occurrence Handle1:STN:280:DC%2BD3s%2FmtFKjsA%3D%3D Occurrence Handle12360372
JW Milsom KA Hammerhofer B Bohm P Marcello P Elson VW Fazio (2001) ArticleTitleProspective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease Dis Colon Rectum 44 1–9 Occurrence Handle1:STN:280:DC%2BD38%2FnvVGjtg%3D%3D Occurrence Handle11805557
AJ Senagore HJ Duepree CP Delaney S Dissanaike KM Brady VW Fazio (2002) ArticleTitleCost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences Dis Colon Rectum 45 485–90 Occurrence Handle12006930
M Braga A Vignali L Gianotti et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery: a randomized trial on short-term outcome Ann Surg 236 759–67 Occurrence Handle12454514
AE Chapman MD Levitt P Hewett R Woods H Sheiner GJ Maddern (2001) ArticleTitleLaparoscopic-assisted resection of colorectal malignancies: a systematic review Ann Surg 234 590–606 Occurrence Handle10.1097/00000658-200111000-00003 Occurrence Handle1:STN:280:DC%2BD3MnmvFChsg%3D%3D Occurrence Handle11685021
AM Lacy JC Garcia-Valdecasas JM Pique et al. (1995) ArticleTitleShort-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer Surg Endosc 9 1101–5 Occurrence Handle1:STN:280:DyaK287hvVWjsA%3D%3D Occurrence Handle8553212
S Yamamoto M Watanabe H Hasegawa H Baba N Hideki M Kitajima (2003) ArticleTitleOncologic outcome of laparoscopic surgery for T1 and T2 colorectal carcinoma Hepatogastroenterology 50 396–400 Occurrence Handle12749231
AJ Senagore KM Madbouly VW Fazio HJ Duepree KM Brady CP Delaney (2003) ArticleTitleAdvantages of laparoscopic colectomy in older patients Arch Surg 138 252–6 Occurrence Handle12611568
JJ Tuech P Pessaux N Regenet et al. (2001) ArticleTitleLaparoscopic colectomy for sigmoid diverticulitis: a prospective study in the elderly Hepatogastroenterology 48 1045–7 Occurrence Handle1:STN:280:DC%2BD3MvksFOjsQ%3D%3D Occurrence Handle11490796
P Gervaz A Pikarsky M Utech et al. (2001) ArticleTitleConverted laparoscopic colorectal surgery Surg Endosc 15 827–32 Occurrence Handle1:STN:280:DC%2BD3MrksFSitg%3D%3D Occurrence Handle11443444
CM Schlachta J Mamazza R Gregoire SE Burpee KT Pace EC Poulin (2003) ArticleTitlePredicting conversion in laparoscopic colorectal surgery. Fellowship training may be an advantage Surg Endosc 17 1288–91 Occurrence Handle1:STN:280:DC%2BD2c7ks1Krtg%3D%3D Occurrence Handle12739116
O Schwandner TH Schiedeck H Bruch (1999) ArticleTitleThe role of conversion in laparoscopic colorectal surgery: do predictive factors exist? Surg Endosc 13 151–6 Occurrence Handle1:STN:280:DyaK1M7hslCrsQ%3D%3D Occurrence Handle9918619
FD Loffer D Pent (1976) ArticleTitleLaparoscopy in the obese patient Am J Obstet Gynecol 125 104–7 Occurrence Handle1:STN:280:DyaE283gtlemtw%3D%3D Occurrence Handle132120
S Pandya JJ Murray JA Coller LC Rusin (1999) ArticleTitleLaparoscopic colectomy: indications for conversion to laparotomy Arch Surg 134 471–5 Occurrence Handle1:STN:280:DyaK1M3lsV2qtQ%3D%3D Occurrence Handle10323418
HH Chen SD Wexner AJ Iroatulam et al. (2000) ArticleTitleLaparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus Dis Colon Rectum 43 61–5 Occurrence Handle1:STN:280:DC%2BD3c3ntFagsQ%3D%3D Occurrence Handle10813125
S Benoist Y Panis A Alves P Valleur (2000) ArticleTitleImpact of obesity on surgical outcomes after colorectal resection Am J Surg 179 275–81 Occurrence Handle1:STN:280:DC%2BD3czjs1eqtA%3D%3D Occurrence Handle10875985
F Marusch I Gastinger C Schneider et al. (2001) ArticleTitleImportance of conversion for results obtained with laparoscopic colorectal surgery Dis Colon Rectum 44 207–16 Occurrence Handle1:STN:280:DC%2BD3M7ot1Sluw%3D%3D Occurrence Handle11227937
ACKNOWLEDGMENTS
The authors thank Mr. and Mrs. Krause-Leiberman whose donation continues to support research into laparoscopic colorectal surgery at this institution.
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Delaney, C., Pokala, N., Senagore, A. et al. 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 (2005). https://doi.org/10.1007/s10350-004-0941-0
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DOI: https://doi.org/10.1007/s10350-004-0941-0