title: The impact of obesity on technical feasibility and postoperative outcomes of laparoscopic left colectomy.
abstract: OBJECTIVE
  To compare technical aspects and postoperative outcomes of laparoscopic left colectomy in obese and nonobese patients.
  
  
  BACKGROUND
  Obesity has been generally associated with increased surgical risk. The data regarding outcomes after laparoscopic colectomy in obese and nonobese patients are limited and quite controversial; however, most reports have suggested that obesity is associated with a greater technical difficulty as well as an increased risk for conversions and postoperative complications.
  
  
  METHODS
  All patients undergoing laparoscopic left colectomy for any pathologic condition between January 2001 and January 2003 were analyzed. Patients with a body mass index (BMI) above 30 kg/m were defined as obese and patients with BMI below 30 kg/m were defined as nonobese. Data collected included age, gender, BMI, American Society of Anesthesiologists score, diagnosis, technical parameters of the procedure, operative time, conversion, pathology, length of hospital stay, and complications over a 30-day postoperative course.
  
  
  RESULTS
  A total of 123 patients underwent elective laparoscopic left colectomy during the 2-year period. Twelve patients were excluded from analysis because missing data did not allow calculation of their BMI. Of the 111 patients analyzed, 23 (20.7%) were obese and 88 patients (79.3%) were nonobese. Patients' preoperative clinical characteristics were similar in obese and nonobese patients except for BMI (P > 0.001). There were no significant differences between the 2 groups with respect to intraoperative parameters, duration of the operation, resection margin, and number of harvested nodes as well as overall postoperative complication rates. There were no conversions in the obese patients, whereas 5 procedures in the nonobese group required conversion to open surgery (P = not significant). Obese patients had shorter hospital stays than nonobese subjects (7 +/- 2.5 days vs. 9.5 +/- 7 days; P = 0.018).
  
  
  CONCLUSIONS
  In contrast with previously reported series of laparoscopic colectomy, our findings show that obesity does not have an adverse impact on the technical difficulty and postoperative outcomes of laparoscopic left colectomy. Our study supports the safety of using laparoscopic surgery for colorectal diseases in obese patients.
authors.affiliation: IRCAD/European Institute of Telesurgery, Université Louis Pasteur, Strasbourg, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Leroy
authors.forename: Pascal
authors.initials: P
authors.lastname: Ananian
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
authors.forename: Bertrand
authors.initials: B
authors.lastname: Claudon
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000601:surgery; D015897:Comorbidity; D043963:Diverticulosis, Colonic / Q000453:epidemiology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome