title: Is the laparoscopic approach to colectomy safe for the morbidly obese?
abstract: BACKGROUND
  The feasibility and safety of laparoscopic colectomy (LC) for morbidly obese patients has not been reported previously. This study aimed to assess the clinical outcomes of patients with a body mass index (BMI) of 40 kg/m(3) or more who undergo laparoscopic colorectal surgery.
  
  
  METHODS
  Prospectively accrued data for patients with a BMI of 40 kg/m(3) or more (group A) who undergo LC were compared with those for patients with BMI lower than 30 kg/m(3) (group B) matched for year of surgery, indication, operating surgeon, and type of procedure.
  
  
  RESULTS
  Each group had 36 patients. The group A patients were significantly younger (54 vs. 61 years; P = 0.04), had higher American Society of Anesthesiology (ASA) scores (P = 0.001), and had diabetes mellitus (P = 0.04). The indications for surgery and the operations performed were similar. The two groups had similar operating times (177.9 vs. 136.4 min; P = 0.12), estimated blood losses (222.3 vs. 157 ml; P = 0.1), median lengths of hospital stay (LOS) (4.5 vs. 4 days; P = 0.2), and returns of bowel function (4.2 vs. 3.9 days; P = 0.45). Group A had significantly longer incisions (6.9 vs. 5 cm; P = 0.02). Conversions (5 vs. 3 patients; P = 0.7), readmissions (12 vs. 6 patients; P = 0.46), reoperations (5 vs. 3 patients; P = 0.17), wound infections (7 vs. 2 patients; P = 0.14), anastomotic leaks (3 vs. 2 patients; P = 0.7), and abdominal abscesses (3 vs. 2 patients; P = 0.7) were more predominant in group A, although the differences did not reach statistical significance.
  
  
  CONCLUSIONS
  Laparoscopic colectomy is feasible for morbidly obese patients and results in recovery of intestinal function and LOS equivalent to that for nonobese patients. As expected, morbidity and conversion rates are higher for morbidly obese patients undergoing LC than for nonobese patients.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Wisam
authors.initials: W
authors.lastname: Khoury
authors.forename: Ravi P
authors.initials: RP
authors.lastname: Kiran
authors.forename: Timothy
authors.initials: T
authors.lastname: Jessie
authors.forename: Daniel
authors.initials: D
authors.lastname: Geisler
authors.forename: Feza H
authors.initials: FH
authors.lastname: Remzi
mesh_terms: D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D003108:Colonic Diseases / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology