title: Sagittal abdominal diameter is a better predictor than body mass index for duration of laparoscopic left colectomy.
abstract: BACKGROUND
  Visceral obesity (VO) increases technical difficulty in laparoscopic surgery. The body mass index (BMI) does not always correlate to intra-abdominal fat distribution. Our hypothesis was that simple anthropometric measures that reflect VO, could predict technical difficulty in laparoscopic colorectal surgery, as reflected by the operative time, more accurately than the BMI.
  
  
  METHODS
  Charts of all consecutive patients who underwent laparoscopic left colon resection in our institution between 2007 and 2010 were reviewed retrospectively. On a preoperative CT scan, anthropometric measures were taken on an axial plane at the L4-L5 level. Demographic, operative and anthropometric CT measures were correlated with the operative time. Logistic regression analysis was performed to assess the value of anthropometric CT measures or BMI to predict the duration of the colectomy.
  
  
  RESULTS
  121 patients with elective left colon resection for benign (56%) or malignant disease (44%) were included. There were 74 sigmoid resections (61%), 21 left hemicolectomies (17%) and 26 low anterior resections (22%). A longer sagittal abdominal diameter (≥24.8 cm) was significantly associated with longer corrected operative time (248 vs. 228 min, p = 0.043). In multivariate analysis, greater sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter were significantly associated with longer operative time. No significant association was found for the BMI neither in univariate nor in multivariate analysis.
  
  
  CONCLUSIONS
  This study suggests that simple linear measures taken on a CT scan, such as sagittal abdominal diameter, sagittal internal diameter and abdominal perimeter, may predict longer operative time in laparoscopic left colonic resections more accurately than BMI.
authors.affiliation: Department of Visceral Surgery, CHUV, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland, daniel.clerc@chuv.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Clerc
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blaser
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Christoforidis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D005260:Female; D006801:Humans; D050152:Intra-Abdominal Fat; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056128:Obesity, Abdominal / Q000000981:diagnostic imaging; D061646:Operative Time; D012189:Retrospective Studies; D064346:Sagittal Abdominal Diameter; D014057:Tomography, X-Ray Computed