title: Does morbid obesity change outcomes after laparoscopic surgery for inflammatory bowel disease? Review of 626 consecutive cases.
abstract: BACKGROUND
  Little is known about the impact of obesity on morbidity in patients with inflammatory bowel disease (IBD) who are undergoing laparoscopic resections. The aim of this study was to evaluate outcomes in a consecutive series of normal weight (NW), overweight (OW), and obese (OB) patients undergoing elective laparoscopic colorectal surgery for IBD.
  
  
  METHODS
  This study is a retrospective analysis of a prospectively collected, Institutional Review Board-approved IBD database.
  
  
  RESULTS
  Laparoscopic colorectal resection was performed in 626 patients (335 NW, 206 OW, and 85 OB) between August 2002 and December 2011. Operative time and blood loss were significantly higher in the OW and OB groups compared with the NW group (p = 0.001 and p < 0.001). No differences were observed in terms of intraoperative blood transfusions (p = 0.738) or complications (p = 0.196). The OW and OB groups had a significantly higher conversion rate (p = 0.049 and p = 0.037) and a longer incision compared with the NW group (p = 0.002 and p < 0.001). Obesity was an independent predictor of conversion to open surgery. No significant differences between groups were observed in terms of overall 30-day postoperative morbidity (p = 0.294) and mortality (p = 0.796). Long-term complications occurred in 6.3% NW, 7.3% OW, and 4.7% OB patients (p = 0.676). Incisional hernias were more common in the OB group compared with the NW group (p = 0.020). On multivariate analysis, obesity was not an independent risk factor for either early or late postoperative complications.
  
  
  CONCLUSIONS
  Obesity increases the complexity of laparoscopic resections in IBD with higher blood loss, operative time, and conversion rates, without worsening outcomes.
authors.affiliation: Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL 60637, USA. mkrane@surgery.bsd.uchicago.edu
authors.forename: Mukta K
authors.initials: MK
authors.lastname: Krane
authors.forename: Marco E
authors.initials: ME
authors.lastname: Allaix
authors.forename: Marco
authors.initials: M
authors.lastname: Zoccali
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.forename: Michele A
authors.initials: MA
authors.lastname: Rubin
authors.forename: Anthony
authors.initials: A
authors.lastname: Villa
authors.forename: Roger D
authors.initials: RD
authors.lastname: Hurst
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications*; D061646:Operative Time; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome