title: Short and long-term outcomes of laparoscopic colectomy in obese patients.
abstract: OBJECTIVE
  To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.
  
  
  METHODS
  A total of 98 obese (body mass index > 30 kg/m(2)) patients who underwent laparoscopic (LPS) right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy. Controls were selected to match for body mass index, site of primary disease, American Society of Anesthesiologists score, and year of surgery (± 3 year). The parameters analyzed included age, gender, comorbid conditions, American Society of Anaesthesiologists class, diagnosis, procedure, and duration of operation, operative blood loss, and amount of homologous blood transfused. Conversion rate, intra and postoperative complications as were as reoperation rate, 30 d and long-term morbidity rate were also analyzed. For continuous variables, the Student's t test was used for normally distributed data the Mann-Whitney U test for non-normally distributed data. The Pearson's χ(2) tests, or the Fisher exact test as appropriate, were used for proportions.
  
  
  RESULTS
  Conversion to open surgery was necessary in 13 of 98 patients (13.3%). In the LPS group, operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy (P = 0.03, P = 0.0001, respectively). Overall morbidity, anastomotic leak and readmission rate did not significantly differ between the two groups. A trend toward a reduction of wound complications was observed in the LPS when compared to open group (P = 0.09). In the LPS group, an earlier recovery of bowel function (P = 0.001) and a shorter length of stay (P = 0.03) were observed. After a median follow-up of 62 (range 12-132) mo 23 patients in the LPS group and 38 in the open group experienced long-term complications (LPS vs open, P = 0.03). Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one (P = 0.03).
  
  
  CONCLUSIONS
  Laparoscopic colectomy in obese patients is safe, does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.
authors.affiliation: Andrea Vignali, Paola De Nardi, Luca Ghirardelli, Saverio Di Palo, Carlo Staudacher, Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, 20132 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vignali
authors.forename: Paola
authors.initials: P
authors.lastname: De Nardi
authors.forename: Luca
authors.initials: L
authors.lastname: Ghirardelli
authors.forename: Saverio
authors.initials: S
authors.lastname: Di Palo
authors.forename: Carlo
authors.initials: C
authors.lastname: Staudacher
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Colon cancer; Colorectal disease; Laparoscopy; Left colectomy; Obesity; Right colectomy