title: The impact of obesity on perioperative outcomes after laparoscopic colorectal resection.
abstract: OBJECTIVE
  It is commonly perceived that surgery in obese patients is associated with worse outcomes than in nonobese patients. Because of the increasing prevalence of obesity and colonic diseases in the world population, the impact of obesity on outcomes of laparoscopic colectomy remains an important subject. The aim of this review was to evaluate the feasibility and safety of laparoscopic colectomy for colorectal diseases in obese patients compared with nonobese patients.
  
  
  METHODS
  We conducted a comprehensive review for the years 1983-2010 to retrieve all relevant articles.
  
  
  RESULTS
  A total of 33 studies were found to be eligible and included 3 matched case control studies and 1 review article. Obesity, often accompanied by preexisting comorbidities, was associated with longer operative times and higher rates of conversion to open procedures mainly because of the problem of exposure and difficulties in dissection. Although some studies showed obesity was associated with increased postoperative morbidity including cardiopulmonary and systemic complications, or ileus leading to longer hospital stay, there was no evidence about the negative impact of obesity on intraoperative blood loss, perioperative mortality, and reoperation rate. Whether obesity is a risk factor for wound infection after laparoscopic colectomy remains unclear. Though sometimes in obese patients, additional number of ports were necessary to successfully complete the procedure laparoscopically, obesity did not influence the number of dissected lymph nodes in cancer surgery. Lastly, the postoperative recovery of gastrointestinal function was similar between obese and nonobese patients.
  
  
  CONCLUSIONS
  Laparoscopic colorectal surgery appears to be a safe and reasonable option in obese patients offering the benefits of a minimally invasive approach, with no evidence for compromise in treatment of disease.
authors.affiliation: Section of Colon and Rectal Surgery, New York Presbyterian Hospital and Weill Cornell Medical College, New York, NY 10065, USA.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.forename: Parul J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: Francesco
authors.initials: F
authors.lastname: Rubino
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Milsom
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003082:Colectomy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome