Madhu Ragupathi, MD, Deborah S Keller, MS, MD, Javier Nieto, MD, Sergio Ibarra, MD, Juan R Flores-Gonzales, MD, Ali Mahmood, MD, Thomas B Pickron, MD, FACS, Eric M Haas, MD, FACS, FASCRS. Colorectal Surgical Associates
Introduction: Our objective was to evaluate the feasibility and efficacy of Single-incision Laparoscopic Colectomy (SILC) in obese patients. SILC is safe and feasible for treating benign and malignant colorectal disease. SILC offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited due to concerns of greater technical difficulty, oncologic compromise, and higher complication and conversion rates.
Methods and Procedures: Review of a prospective database identified elective SILC patients from 2009-2013. Patients were stratified into obese (BMI ≥30 kg/m2) and non-obese cohorts (BMI <30 kg/m2), then matched on age, gender, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were conversion, operative time, length of stay (LOS), complications, and readmissions for each cohort.
Results: 160 patients were evaluated- 80 in each cohort. Patients were similar in age (p=0.93), gender (p=1), prior abdominal surgery (p=0.11), indication for surgery (p=1), and procedure (p=1). The obese cohort had significantly higher BMI (p<0.001) and ASA scores (p<0.001). Operative time (176.9±64.0 min vs. 144.4±47.2 min, p<0.001), blood loss (89.0±139.5 ml vs. 51.6±38.0 ml, p<0.001), and final incision length (4.0±1.5 cm vs. 3.5±1.1 cm, p=0.008) were significantly higher in the obese. However, specimen length (p=0.31) and lymph node harvest (p=0.76) were comparable between cohorts for malignant cases. Furthermore, there was no significant differences in LOS (p=0.33), conversion rates (p=0.41), postoperative complications (p=0.30), or readmission rates (p=1).
Conclusions: Single-incision laparoscopic colectomy is safe and feasible in obese patients for benign and malignant disease. Cases are technically challenging and require advanced laparoscopic skills. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILC may offer a practical approach to optimize patient outcomes in colorectal surgery.
|
Outcomes for Non-obese and Obese Patients Undergoing SILC |
Non-obese (n=80) |
Obese (n=80) |
p-value |
| Mean BMI (SD, kg/m2) | 22.8±2.3 |
33.4±3.2 |
0.001* |
| ASA (n,%) | 0.001* | ||
| I | 4 (5.0%) | 1 (1.3%) | |
| II | 56 (70.0%) |
34 (43.0% |
|
| III | 20 (20.0%) |
43 (54.4%) |
|
| IV | 0 (0.0%) | 1 (1.3%) | |
| Intraoperative complications (n,%) |
2 (2.5%) |
1 (1.3%) | 0.56 |
| Conversion (n,%) |
2 (2.5%) |
4 (5.0%) | 0.41 |
| Mean Length of Stay (SD, days) |
3.7±2.1 |
4.1±2.2 | 0.33 |
| Postoperative complications (n,%) |
6 (7.5%) |
10 (12.5%) | 0.30 |
| Reoperations (n,%) |
2 (2.5%) |
1 (1.3%) | 0.56 |
| Readmissions (n,%) |
3 (3.8%) |
3 (3.8%) | 1.0 |