Is obesity a high-risk factor for laparoscopic colorectal surgery?

Pikarsky, Alon J.; Saida, Yoshihisa; Yamaguchi, T.; Martinez, S.; Chen, W.; Weiss, Eric G.; Nogueras, Juan J.; Wexner, Steven D.

doi:10.1007/s004640080069

Cited by 244 publications

(242 citation statements)

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“…These technical limitations in the right colon resection of obese patients increase the likelihood of converting an EA technique to a fully open resection. Thus, a totally laparoscopic IA technique may be desirable in obese patients as it may help avoid larger incisions and higher complication rates compared to that of a laparoscopic-assisted EA technique [23]. Additionally, the benefits of smaller incisions achieved by an IA technique decreasing the risk of postoperative pain and incisional hernias have been well established [24,25].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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Background The use of laparoscopy for right hemicolectomy has gained popularity allowing the option of a totally laparoscopic intracorporeal anastomosis (IA) for intestinal reconstruction. This technique may alleviate some of the technical limitations that a surgeon faces with a laparoscopic-assisted extracorporeal anastomosis (EA). Results A total of 195 patients underwent laparoscopic right hemicolectomy over the study period, with 86 (44 %) patients receiving IA and 109 (56 %) patients receiving an EA. The most common indication for surgery in both groups was cancer: 56 (65 %) of IA cases and 57 (52 %) of EA cases. IA had a significantly higher rate of minor complications but no difference in serious complications compared to EA. Conversion to open resection was higher in EA. Using multivariate analysis to compare IA versus EA, there was no significant difference in length of stay, return of bowel function, risk of anastomotic leak, risk of intraabdominal abscess or risk of wound complications. Amongst cancer resections, there was no significant difference in the median number of lymph nodes harvested (18 LNs in IA group vs. 19 LNs in EA group, P > 0.05). There was also no significant difference in overall survival and disease-free survival at 5.7 years between the two groups. MethodsConclusions IA in laparoscopic right hemicolectomy is associated with similar postoperative and oncologic outcomes compared to EA. IA may possess advantages in terms of conversion and flexibility of specimen extraction, but this is counterbalanced by a higher incidence of minor complications. These findings suggest that IA represents a valid technique in the arsenal of the experienced colorectal surgeon without compromising outcomes.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic right hemicolectomy: short- and long-term outcomes of intracorporeal versus extracorporeal anastomosis

et al. 2015

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“…Surgeons have generally thought that obesity might possibly increase the incidences of intraoperative and/ or postoperative anesthetic complications [14], intraoperative bleeding, and surgical complications, and it is also thought that obesity may increase operation times and the risk of cardiopulmonary diseases [9,10]. Some studies have reported the effect of obesity on open gastric cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons have long thought that obesity might increase the rate of intraoperative or postoperative complications [9,10]. A recent report from Japan concluded that a higher BMI hampered the performance of lymphadenectomy during gastric cancer surgery, and a higher BMI was reported as an independent predictor of cancer recurrence [11].…”

Section: Introductionmentioning

confidence: 99%

The impact of obesity on LADG for early gastric cancer

Kim

Jung

et al. 2006

Gastric Cancer

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“…Some reports have demonstrated that obesity is associated with high conversion rates [16][17][18]. One of the difficulties of performing laparoscopic surgery on obese patients is obtaining good visualization of the surgical field.…”

Section: Discussionmentioning

confidence: 99%