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Laparoscopic colectomy in the obese, morbidly obese, and super morbidly obese: when does weight matter?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Previous studies have demonstrated that obese patients (BMI >30) undergoing laparoscopic colectomy have longer operative times and increased complications when compared to non-obese cohorts. However, there is little data that specifically evaluates the outcomes of obese patients based on the degree of their obesity. The aim of this study was to evaluate the impact of increasing severity of obesity on patients undergoing laparoscopic colectomy.

Methods

A retrospective review was performed of all patients undergoing laparoscopic colectomy between 1996 and 2013. Patients were classified according to their BMI as obese (BMI 30.0–39.9), morbidly obese (BMI 40.0–49.9), and super obese (BMI >50). Main outcome measures included conversion rate, operative time, estimated blood loss, post-operative complications, and length of stay.

Results

There were 923 patients who met inclusion criteria. Overall, 604 (65.4%), 257 (27.9%), and 62 (6.7%) were classified as obese (O), morbidly obese (MO), and super obese (SO), respectively. Clinicopathologic characteristics were similar among the three groups. The SO group had significantly higher conversion rates (17.7 vs. 7 vs. 4.8%; P = 0.031), longer average hospital stays (7.1 days vs. 4.9 vs. 3.4; P = 0.001), higher morbidity (40.3 vs. 16.3 vs. 12.4%; P = 0.001), and longer operative times (206 min vs. 184 vs. 163; P = 0.04) compared to the MO and O groups, respectively. The anastomotic leak rate in the SO (4.8%; P = 0.027) and MO males (4.1%; P = 0.033) was significantly higher than MO females (2.2%) and all obese patients (1.8%).

Conclusion

Increasing severity of obesity is associated with worse perioperative outcomes following laparoscopic colectomy.

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Author information

Authors and Affiliations

  1. Department of Surgery, Fairview Hospital, 18101 Lorain Avenue, Cleveland, OH, 44111, USA

    Bradley J. Champagne

  2. Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Madhuri Nishtala, Justin T. Brady & Benjamin P. Crawshaw

  3. Texas Endosurgery Institute, 8019 New Braunfels, Suite 115, San Antonio, TX, 78235, USA

    Morris E. Franklin

  4. Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Conor P. Delaney

  5. Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Scott R. Steele

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  1. Bradley J. Champagne
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  2. Madhuri Nishtala
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  3. Justin T. Brady
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Contributions

All above authors meet the following conditions for authorship: (a) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; (c) final approval of the version to be published.

Corresponding author

Correspondence to Scott R. Steele.

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Financial disclosure

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

Ms. Madhuri Nishtala, Dr. Benjamin P. Crawshaw, Dr. Morris E. Franklin, and Justin T. Brady have no conflicts of interest or financial ties to disclose. Scott R. Steele reports receiving personal fees from Ethicon and Medtronic outside the submitted work. Conor P. Delaney reports receiving personal fees from Ethicon and Merck Pharmaceuticals outside the submitted work. Bradley J. Champagne reports receiving personal fees from Medtronic, outside the submitted work.

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Champagne, B.J., Nishtala, M., Brady, J.T. et al. Laparoscopic colectomy in the obese, morbidly obese, and super morbidly obese: when does weight matter?. Int J Colorectal Dis 32, 1447–1451 (2017). https://doi.org/10.1007/s00384-017-2865-x

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  • DOI: https://doi.org/10.1007/s00384-017-2865-x

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