Is obesity a contraindication for laparoscopic colectomy?

Maria C Mora Pinzon, MD, Alan Goldberg, Amanda B Francescatti, Marc I Brand, MD, Dana M Hayden, MD, MPH, Theodore J Saclarides, MD, FACS

Rush University Medical Center, Loyola University Medical Center,

Background: Obese patients undergoing surgery have higher postoperative complications, laparoscopy is extremely difficult in this setting. Should obesity be a contraindication for laparoscopic surgery? The purpose of our study was to describe the outcomes of surgery in obese patients.

Methods: We performed a retrospective review of prospectively collected database that included patients who underwent laparoscopic colectomy between 2007 – 2012. Outcomes in patients with BMI >30, 35-40 and >40 were compared to BMI <30, and to obese patients that underwent open surgery.

Results: We identified 414 patients that underwent laparoscopic colectomy. 232 (56%) were female and average age was 55.47 (range 16-94). The most common indications were tumors (37% malignant and 14.3% bening), diverticular disease (19.3%), and ulcerative colitis (11.4%). 28% were right colectomies, 34.8% left colectomies, 21.7% total colectomies, and 15.5% rectal resection (LAR/APR). 29.2% of the patients were obese. The average operative time was longer for obese patients (251 vs 233 min, p=0.047). Length of stay was significantly longer for patients with BMI 35-40 and >40 (9.1, and 8.6 vs. 7.4 p= 0.04). Patients with BMI >35 had an increased risk of thrombotic complications (X2= 9.8 p=0.002), and a tendency toward increased rates of wound infection (X2= 2.841, p= 0.092). A second analysis was performed comparing open vs. laparoscopic surgery among obese patients. Patients in the laparoscopic group had a lower rate of ileus (X2=5.58 , p=0.018 ), wound infection (X2=7.4 , p=0.006), and ICU admission (X2=4.963, p=0.026). The 30 days complication rates were 17.8% for laparoscopy surgery and 12.9% for open surgery (p=0.37). Operative time was not significantly different (251 vs. 244 p=0.638). Length of stay was shorter in the laparoscopic group (7.57 vs. 9.24 p=0.08).

Conclusions: Although laparoscopic surgery in obese patients in technically challenging, obesity by itself is not a contraindications for laparoscopy. Obese patients benefit from laparoscopy, evidenced by lower risk of wound infections, ileus and ICU admission.

Key words: obesity, laparoscopy, colectomy, contraindication

Session: Poster Presentation

Program Number: P081

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