Should completely intracorporeal anastomosis be considered in obese patients who undergo laparoscopic colectomy for benign or malignant disease of the colon?
BACKGROUND
The outcome of laparoscopic colectomy with completely intracorporeal anastomosis (LCIA) in obese and nonobese patients is assessed.


METHODS
Forty-five consecutive patients who underwent LCIA for benign or malignant disease of the right and proximal left colon were reviewed prospectively. Obesity was defined as a body mass index of >30 kg/m(2).


RESULTS
There were 24 men (53%) and 21 women (47%) with a mean age of 67 years (46-84 years). The mean body mass index was 27 kg/m(2) (16-38 kg/m(2)); 13 patients (29%) were obese. One procedure was converted to a laparoscopic-assisted colectomy. The mean operative time, estimated blood loss, and duration of stay were 218 minutes (110-420 minutes), 82 mL (50-250 mL), and 5 days (2-11 days), respectively. The mean length of the larger incision (extraction site) and the sum of all port incisions was 4 cm (3-8 cm) and 7 cm (6-10 cm), respectively. Complications occurred in 8 of 45 patients (18%), with no deaths. The mean number of harvested lymph nodes per specimen was 11 (3-30 lymph nodes). Obesity had no effect on operative time (obese patients, 232 minutes; nonobese patients, 213 minutes), incision length (obese patients, 4 cm; nonobese patients, 4 cm) estimated blood loss (obese patients, 100 mL; nonobese patients, 76 mL), complications (obese patients, 15%; nonobese patients, 19%), duration of stay (obese patients, 5 days; nonobese patients, 5 days), or number of harvested lymph nodes (obese patients, 11 lymph nodes; nonobese patients, 11 lymph nodes). There were no port-site hernias or metastases during a mean follow-up period of 5 months (1-18 months).


CONCLUSIONS
LCIA can offer smaller incisions, improved cosmesis, and low conversion rates while oncologic principles are preserved. LCIA is a feasible and safe technique with equally successful outcomes in thin and obese patients.
Raftopoulos
Ioannis
I
Division of Minimally Invasive, Bariatric and General Surgery, UPMC Shadyside & Magee Women's Hospitals, University of Pittsburgh, PA, USA.
Courcoulas
Anita P
AP
Blumberg
David
D
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome