Challenges of laparoscopic colectomy in the obese patient: a review

Background: Perioperative care of clinically severely obese patients presents numerous unique challenges. These patients have distinctive issues with regard to cardiovascular, pulmonary, and thromboembolic complications. In addition, hospital equipment must be able to accommodate the body habitus of this population. Methods: A Medline search using the terms "morbid obesity," "colon resection," "obesity comorbidities," "laparoscopic colectomy," perioperative challenges," and "risk factors" was performed for English-language articles. Further references were obtained through cross-referencing the bibliography cited in each publication. Results: The authors discussed the most relevant challenges surgeons encounter in the perioperative setting when treating obese patients. Comments: The management of the morbidly obese patient requires meticulous preoperative, intraoperative, and postoperative care. Colorectal suraeons should be familiar with obesity-related problems when treating colorectal disease processes in this patient population. The associated comorbid illnesses in this population, as well as the technical difficulties regularly posed by them, make laparoscopic colectomy a more challenging procedure than normally encountered in the nonobese patient population. (c) 2006 Excerpta Medica Inc. All rights reserved.