title: Laparoscopic colorectal surgery in the complicated patient.
abstract: BACKGROUND
  Major comorbidities are recognized risk factors in colorectal surgery. We examine here the feasibility and safety of laparoscopic colorectal surgery (LC) in the complicated, high-risk patient.
  
  
  METHODS
  From July 2003 to October 2004, 107 consecutive patients undergoing LC were prospectively studied. Complicated patients were defined as age >80 years, body mass index (BMI) >30, and/or American Society of Anesthesiology level III or IV. A group of case-matched controls undergoing open surgery (OC) during a similar time period were retrospectively reviewed. The 2 groups were compared and assessed for major and minor morbidity and mortality.
  
  
  RESULTS
  Overall morbidity was higher in the OC group 52% versus 26%. Minor complications compared at 31% OC versus 9% LC and major at 21% and 17%, respectively. With LC, advancement to discharge was more rapid and discharge home more likely than to a care facility.
  
  
  CONCLUSIONS
  With proper patient selection and laparoscopic experience, LC can be performed in the complicated patient without undue morbidity and mortality.
authors.affiliation: Section of Colorectal Surgery, St. Vincent Health System, Erie, PA, USA.
authors.forename: Margaret D
authors.initials: MD
authors.lastname: Plocek
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Geisler
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Glennon
authors.forename: Phillip
authors.initials: P
authors.lastname: Kondylis
authors.forename: John C
authors.initials: JC
authors.lastname: Reilly
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome