Laparoscopic colorectal surgery in obese patients

Background: The aim of the study was to the evaluate results of laparoscopic colorectal surgery in obese patients. Methods: All patients who underwent elective laparoscopic colorectal surgery from January 1993 to December 2003 were included in the study. BMI > 30 was used as an objective obesity criterion. The evaluated parameters included BMI, age, sex, diagnosis and associated diseases, American Society of Anesthesiologists classification score (ASA), type and duration of procedure, peroperative and postoperative complications, postoperative course, reoperation, length of hospitalization, morbidity and early mortality. Results: 435 patients were evaluated. There were 80 patients (18%) in the obese group, and 355 patients (82%) were non-obese. The samples were comparable in terms of age, gender, ASA, diagnosis and procedure. Peroperative complications occurred more frequently in the obese group of patients (4% vs 2.5% P > 0.05) and the operating time was longer as well (151 min vs 141 min, P > 0.05), both statistically not significant. There was no difference in postoperative course in both groups with regard to intravenous administration of analgesics (2 days), start of solid diet (day 3) and first bowel movement (day 4). Morbidity was higher in the obese group of patients (33% vs 24%, P > 0.05), and reoperations were also more frequent here (13% vs 7%, P > 0.05), which was reflected in prolonged hospital stay (14 days vs 12 days, P > 0.05). On the other hand, early mortality was surprisingly lower in the obese group of patients (2.5% vs 6%, P > 0.05). However, none of these differences achieved statistical significance on the set significance level of P = 0.05. Conclusion: With sufficient experience, laparoscopic colorectal surgery in obese patients is feasible and safe. It is associated with no increased risk of complications and preserves all benefits of the mini-invasive approach.