title: Impact of obesity on laparoscopic-assisted left colectomy in different stages of the learning curve.
abstract: OBJECTIVE
  This study is aimed at verifying if the surgeon's experience has an impact on the risk of conversion to open surgery of laparoscopic left colectomy performed in obese patients.
  
  
  METHODS
  A multiple logistic regression analysis was performed of 181 laparoscopic left hemicolectomies completed between April 2001 and June 2006. The results were analysed statistically in relation to the learning curve, by comparing factors that could have had an impact on the risk of conversion in the first 91 cases and in the last 90 cases.
  
  
  RESULTS
  The overall conversion rate was 11%. Only weight level was found to be predictive of conversion to open surgery. No death was observed. Sixteen patients presented postoperative complications (8.8%), with no significant differences between obese and nonobese patients (P=0.95). The conversion rate was higher in the group of the first 91 cases: 15.6% versus 6.6% (P=0.05). Average body mass index of converted patients resulted as being higher than that of nonconverted ones (29.97+/-3.76 vs. 25.48+/-3.72; P<0.001) during the first period of the learning curve, but the difference was not observed during the second period (P=0.87). On multiple logistic regression analysis, obesity was found to be predictive of conversion only during the first period.
  
  
  CONCLUSIONS
  The data indicate that the laparoscopic colorectal surgery is feasible and effective in obese patients both when the surgeon is expert in laparoscopic colorectal resection and at the initial phase of the experience. At the initial phase of the experience obesity constitutes a higher risk of conversion to open surgery.
authors.affiliation: Department of Surgical Sciences, Section of General Surgical Clinics and Surgical Therapy, Parma University Medical School, Parma, Italy. leosarli@unipr.it
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Sarli
authors.forename: Alessio
authors.initials: A
authors.lastname: Rollo
authors.forename: Stefano
authors.initials: S
authors.lastname: Cecchini
authors.forename: Gabriele
authors.initials: G
authors.lastname: Regina
authors.forename: Giuliano
authors.initials: G
authors.lastname: Sansebastiano
authors.forename: Federico
authors.initials: F
authors.lastname: Marchesi
authors.forename: Licia
authors.initials: L
authors.lastname: Veronesi
authors.forename: Michelina
authors.initials: M
authors.lastname: Ferro
authors.forename: Luigi
authors.initials: L
authors.lastname: Roncoroni
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D003113:Colonoscopy / Q000379:methods*; D003107:Colorectal Surgery / Q000295:instrumentation / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007258:Informed Consent; D007858:Learning; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome