Outcomes after laparoscopic intestinal resection in obese versus non-obese patients.
BACKGROUND
The degree of benefit derived from laparoscopic bowel resection in obese compared with non-obese patients is poorly understood.


METHODS
A total of 436 obese patients (body mass index (BMI) at least 30 kg/m(2), mean 34·9 kg/m(2)) who underwent laparoscopic bowel resection during 1992-2008 were identified from a prospective database. An equal number of non-obese patients (mean BMI 24·8 kg/m(2)) was case-matched by age, sex, year of surgery, American Society of Anesthesiologists score, diagnosis and type of operation. Patients with previous major abdominal surgery were excluded. Postoperative morbidity and recovery were compared between obese and non-obese patients.


RESULTS
Mean duration of operation (171·5 versus 157·3 min; P = 0·017), estimated blood loss (EBL; 224·9 versus 164·6 ml; P = 0·001) and conversion rate (13·3 versus 7·1 per cent; P = 0·003) were increased significantly in obese patients. Overall postoperative morbidity was also greater (32·1 versus 25·7 per cent; P = 0·041), particularly wound infection rate (10·6 versus 4·8 per cent; P = 0·002). Among laparoscopically completed operations, obese patients had higher rates of overall morbidity (31·5 versus 24·2 per cent; P = 0·026) and wound infection (10·2 versus 4·4 per cent; P = 0·002). Conversion was associated with increased EBL, intraoperative complications, overall morbidity and length of stay in both groups. The effect of conversion in worsening outcomes was comparable in obese and non-obese patients, except for a greater increase in incision length (11·0 versus 8·0 cm; P = 0·001) and EBL (304·8 versus 89·8 ml; P = 0·001) in obese patients.


CONCLUSIONS
Laparoscopic bowel resection results in greater morbidity in obese than in non-obese individuals. This difference remains comparable whether the procedure is completed laparoscopically or converted.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
W
W
Khoury
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L
Stocchi
D
D
Geisler
D016063:Blood Loss, Surgical; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011182:Postoperative Care; D016896:Treatment Outcome