Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 14, 2013; 19(42): 7405-7411
Published online Nov 14, 2013. doi: 10.3748/wjg.v19.i42.7405
Short and long-term outcomes of laparoscopic colectomy in obese patients
Andrea Vignali, Paola De Nardi, Luca Ghirardelli, Saverio Di Palo, Carlo Staudacher
Andrea Vignali, Paola De Nardi, Luca Ghirardelli, Saverio Di Palo, Carlo Staudacher, Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, 20132 Milan, Italy
Author contributions: Vignali A designed the study and wrote the manuscript; De Nardi P analyzed the data, and revised the article; Ghiradelli L and Di Palo S helped in the acquisition of the data and revised the article; Staudacher C critically revised the manuscript for important intellectual content and gave the final approval.
Correspondence to: Andrea Vignali, MD, Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, Via Olgettina 60, 20132 Milan, Italy.
Telephone: +39-2-26432272 Fax: +39-2-26432856
Received: August 16, 2013
Revised: October 3, 2013
Accepted: October 13, 2013
Published online: November 14, 2013

AIM: To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.

METHODS: A total of 98 obese (body mass index > 30 kg/m2) patients who underwent laparoscopic (LPS) right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy. Controls were selected to match for body mass index, site of primary disease, American Society of Anesthesiologists score, and year of surgery (± 3 year). The parameters analyzed included age, gender, comorbid conditions, American Society of Anaesthesiologists class, diagnosis, procedure, and duration of operation, operative blood loss, and amount of homologous blood transfused. Conversion rate, intra and postoperative complications as were as reoperation rate, 30 d and long-term morbidity rate were also analyzed. For continuous variables, the Student’s t test was used for normally distributed data the Mann-Whitney U test for non-normally distributed data. The Pearson’s χ2 tests, or the Fisher exact test as appropriate, were used for proportions.

RESULTS: Conversion to open surgery was necessary in 13 of 98 patients (13.3%). In the LPS group, operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy (P = 0.03, P = 0.0001, respectively). Overall morbidity, anastomotic leak and readmission rate did not significantly differ between the two groups. A trend toward a reduction of wound complications was observed in the LPS when compared to open group (P = 0.09). In the LPS group, an earlier recovery of bowel function (P = 0.001) and a shorter length of stay (P = 0.03) were observed. After a median follow-up of 62 (range 12-132) mo 23 patients in the LPS group and 38 in the open group experienced long-term complications (LPS vs open, P = 0.03). Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one (P = 0.03).

CONCLUSION: Laparoscopic colectomy in obese patients is safe, does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.

Keywords: Obesity, Colon cancer, Laparoscopy, Right colectomy, Left colectomy, Colorectal disease

Core tip: The best of our knowledge, this is the first case-matched control study reporting long-term complications in obese patients’ undergone laparoscopic or open colectomy.