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Comparative Analysis of Single Incision Colorectal Surgery in Obese and Non-Obese Patients: a Case-Matched Study
Jean-Paul J. Lefave*1, 2, Deborah Keller1, Nisreen Madhoun1, 2, Juan R. Flores1, Madhu Ragupathi1, Sergio Ibarra1, T Bartley Pickron1, 2, Eric M. Haas1, 2
1Colorectal Surgical Associates, Houston, TX; 2Surgery, University of Texas Medical School at Houston, Houston, TX
Background: Obesity is a growing epidemic, and more limitations and complications have been reported operating on the obese. Single incision laparoscopic surgery (SILS) has been shown safe and feasible, but outcomes in the obese have not been fully evaluated. Our goal was to compare short-term outcomes for SILS in obese and non-obese patients.
Methods: Review of a prospective database identified patients undergoing elective SILS colorectal resection from 2009-2014. Patients were stratified into obese (BMI≥30 kg/m2) and non-obese (BMI<30kg/m2) groups, then matched on age, gender, comorbidity, diagnosis, and procedure for control. We assessed demographic, perioperative, and postoperative outcomes variables. The main outcome measures were operative time, conversion rates, length of stay, complication, and readmission rates across obese and non-obese cohorts.
Results: 80 patients were analyzed in each cohort. Obese and non-obese patents were significantly different in BMI (mean 32.90 vs. 25.08; p<0.0001), but well-matched in all other demographics. The main indication for surgery was diverticulitis (32.5% obese, 30.0% non-obese), and the main procedure performed a segmental colectomy in both groups (51.25% obese, 53.75% non-obese). Obese patients had significantly longer operative times (p=0.0030), significantly higher conversion rates (p=0.0284), and trended towards more blood loss (p=0.0683). However, there were no differences in intraoperative complications. The length of stay was comparable (p=0.1370) in the obese and non-obese. Postoperatively, there were no significant differences in complication (p=1.00), readmission (p=1.00), or reoperation rates (p=0.4969).
Conclusions: Our study found single incision laparoscopic colorectal surgery in obese patients was technically challenging, resulting in significantly longer operative times and higher conversion rates. However, the clinical outcomes were favorable and statistically comparable to the non-obese postulation
Patient Outcomes
| Variable | Obese (n=80) | Non-obese (n=80) | p-value | | Intraoperative Conversion (n, %) | 6 (7.5%) | - | 0.0284* | | Mean Operative time (min, SD) | 170.24 (63.04) | 143.61 (51.97) | 0.0030* | | Mean Blood Loss (mL, SD) | 83.00 (139.34) | 50.71 (45.24) | 0.0683 | | Intraoperative Complications (n, %) | 2 (2.5%) | 2 (2.5%) | 1.00 | | Mean Length of Stay (days, SD) | 3.72 (2.31) | 3.24 (1.78) | 0.1370 | | Postoperative Complications (n, %) | 7 (8.75%) | 6 (7.5%) | 1.00 | | Readmission (n, %) | 1(1.25%) | 1(1.25%) | 1.00 | | Reoperation (n, %) | - | 2 (2.5%) | 0.4969 | | Death (n, %) | - | 1 (1.25%) | 1.00 |
SD- Standard Deviation; *- Statistically Significant; 30 day outcomes analyzed
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