Eric M Haas, Ali Aminian, Javier Nieto, Rodrigo Pedraza, Carlos Martinez, Chirag B Patel and Bartley Pickron T
Background: Obesity is associated with increased surgical risk and major abdominal procedures performed in morbidly obese patients may prove challenging when compared with normal weight patients. There are limited data regarding outcomes after minimally invasive colorectal surgery in morbidly obese patients. The aim of this study was to compare the outcomes between morbidly obese and normal weight patients.
Materials and Methods: Forty morbidly obese were matched to three normal weight patients (n=120), based on type of surgical approach and procedure. The patients underwent minimally invasive colorectal surgery by one of two colorectal surgeons. Patients were considered morbidly obese or normal-weight based on body mass index. Demographic data and operative outcomes were compared.
Results: Mean body mass index differed significantly between the morbidly obese (median 43.9 kg/m2) and normal weight (median 22.7 kg/m2) groups, p<0.00001. Both groups were comparable in regards to age, gender, history of prior abdominal operations, and clinical diagnosis. Surgical approaches included multiport laparoscopic colectomy (47.5%), hand-assisted laparoscopic colectomy (35%), robotic-assisted laparoscopic colectomy (12.5%), and single-incision laparoscopic colectomy (5%). The most common procedures were anterior resection (42.5%) and right hemicolectomy (40%). Morbidly obese patients required a significantly longer operative time (median 199 min vs. 139 min, p=0.0004) and resulted in significantly greater blood loss (median 100 cc vs. 75 cc, p=0.004), with no higher conversion rate to open surgery (7.5% vs. 2.5%, p=0.15) compared to normal weight patients. The mean length of hospital stay, 30-day postoperative complication, readmission, and reoperation rates were comparable between groups.
Conclusions: Minimally invasive surgery for the treatment of colorectal disorders in morbidly obese patients results in short-term outcomes comparable to those observed in normal weight patients. Although technically challenging, morbidly obese population may benefit from minimally invasive surgery in regard to enhanced recovery.
