Is Laparoscopic Colectomy Applicable to Patients With Body Mass Index >30? A Case-Matched Comparative Study With Open Colectomy

• Published in: Diseases of the colon & rectum Vol. 48; no. 5; pp. 975 - 981
• Main Authors: Delaney, Conor P, Pokala, Naveen, Senagore, Anthony J, Casillas, Sergio, Kiran, Ravi P, Brady, Karen M, Fazio, Victor W
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Secaucus, NJ The ASCRS 01.05.2005; Springer; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Biological and medical sciences; Body Mass Index; Chi-Square Distribution; Colectomy - methods; Digestive system. Abdomen; Endoscopy; Female; Health Care Costs - statistics & numerical data; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Length of Stay - statistics & numerical data; Male; Medical sciences; Metabolic diseases; Middle Aged; Obesity; Obesity - complications; Postoperative Complications - epidemiology; Prospective Studies; Statistics, Nonparametric; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Human; Obesity; Colorectal; Nutrition disorder; Colectomy; Laparoscopy; Comparative; Open; Case study; Case-matched; Body mass index; Treatment; Surgery; Rectum; Endoscopy; Colon; Laparoscopic; Nutritional status; Comparative study
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/s10350-004-0941-0

PURPOSE: METHODS: RESULTS:The two groups were matched for age (P = 0.06), gender (P = 1), American Society of Anesthesiologists class (P = 0.2), body mass index (P = 0.4), indication for surgery (P = 1), and procedure (P = 1). By using intention-to-treat-type analysis, there was no difference in median operating time (100 vs. 110 (mean, 123 vs. 112) minutes; P = 0.1), complications (21 vs. 24 percent; P = 0.74), readmission (17 vs. 10.6 percent; P = 0.3), reoperation rates (6.4 vs. 4.3 percent; P = 0.75), or direct costs (median, $3,368 vs. $3,552; mean, $4,003 vs. $4,037; P = 0.14) between laparoscopic colectomy or open colectomy; however, the median length of stay (3 vs. 5.5 (mean, 3.8 vs. 5.8) days; P = 0.0001) was significantly shorter after laparoscopic colectomy. Twenty-eight patients required conversion for adhesions (n = 11), bleeding (n = 3), obesity-hindering vision or dissection (n = 9), large phlegmon or tumor (n = 4), and ureteric injury (n = 1). The mean operating time for conversions was 142 minutes and length of stay was 6.4 days. Compared with laparoscopically completed cases, the median length of stay (5 vs. 2 (mean, 6.4 vs. 2.8) days; P = 0.0001) and median operating times (150 vs. 95 (mean, 142 vs. 115) minutes; P = 0.02) were significantly higher in the converted group, but there was no difference in the complication (P = 0.8), readmission (P = 1), or reoperation (P = 0.7) rates. Compared with open colectomy, the operating time (P = 0.02) was significantly higher in the converted group but there were no significant differences in the length of stay (P = 0.18), complication (P = 1), readmission (P = 0.35), or reoperative (P = 1) rates. CONCLUSIONS: