Introduction: Obesity has been challenging for both laparoscopic (LA) surgery and hand-assisted laparoscopic (HAL) surgery. The aim of this study was to compare the outcomes of LA and. HAL colorectal surgery in obese patients.
Methods and procedures: An IRB approved retrospective chart review of a prospectively maintained database was conducted to identify obese patients (BMI>30) who underwent either LA or HAL surgery for elective left colectomy, sigmoid colectomy, low anterior resection and total proctocolectomy between January 2004 and June 2009.
Results: 136 patients were identified 84 in the LA and 52 in the HAL groups of a mean age of 58 and 51 years (p<0.0136) respectively. Both groups were comparable regarding BMI, gender, and ASA scores. The most common indication for surgery was diverticulitis (LA 49 vs. HAL 30) and the most common surgical procedures were sigmoidectomy (LA 53 vs. HAL 32), total colectomy (LA 11 vs. HAL 12), and anterior resection (LA 15 vs. HAL 6). While the HAL group had a statistically significantly shorter operative time (LA 220 vs. HAL 180 min, p=0.0085), reduced blood loss (LA 200 vs. HAL 100 ml, p=0.0012), lower conversion rate (LA 35 vs. HAL 6, p<0.0001), and shorter post operative hospital stay (LA 6 vs. HAL 5 days, p=0.0425), the overall length of incision, intraoperative complications, post operative complications and number of ports were not statistically significant between the two groups. Excluding the operation which were converted the length of incision was significantly shorter in LA group (LA 6 vs. HAL 7.5 cm, p=0.0043) and postoperative hospital stay was similar in both groups (LA 5 vs. HAL 5 days, p=0.6712).
Conclusion: LA and HAL surgical approaches are comparable related to safety and feasibility in obese patients. The length of operation, estimated blood loss, the conversion rate and post operative hospital stay were decreased in HAL group while the length of incision was decreased and postoperative hospital stay was similar with LA group in successfully completed cases. Although HAL may be justifiable in this group of obese patients, the majority of patients who undergo LA surgery can still benefit from a significantly smaller incision.
Program Number: P169