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Laparoscopic Colon Laparoscopic Colon Surgery in the Obese Surgery in the Obese
PatientPatient
Alessio PigazziAlessio PigazziCity of HopeCity of HopeDuarte, CADuarte, CA
Obesity epidemic 2005-Obesity epidemic 2005-20062006
Percent of adults age 20 years and over Percent of adults age 20 years and over who are overweight or obese: who are overweight or obese: 67%67%
Percent of adults age 20 years and over Percent of adults age 20 years and over who are obese: who are obese: 34%34%
Percent of adolescents age 12-19 years Percent of adolescents age 12-19 years who are overweight: who are overweight: 18%18%
Percent of children age 6-11 years who are Percent of children age 6-11 years who are overweight: overweight: 15%15%
Percent of children age 2-5 years who are Percent of children age 2-5 years who are overweight: overweight: 11%11%
Source: CDC
Lap Colon in Obese patientLap Colon in Obese patient
Harder?Harder? Easier?Easier? Contraindicated?Contraindicated? Beneficial?Beneficial? Every obese patient the same?Every obese patient the same?
CaseCase
36 year old woman admitted to the 36 year old woman admitted to the hospital with two week history of hospital with two week history of increasing abdominal distension and increasing abdominal distension and constipation. Last BM/flatus three constipation. Last BM/flatus three days agodays ago
PMHx: Severe obesity BMI 36 PMHx: Severe obesity BMI 36 PE: Obese woman in moderate pain; PE: Obese woman in moderate pain;
no peritoneal signsno peritoneal signs
CaseCase
Ct scan shows obstructing lesion at Ct scan shows obstructing lesion at splenic flexuresplenic flexure
CaseCase
What next? What next? • LaxativesLaxatives• OR open surgeryOR open surgery• OR lap SurgeryOR lap Surgery• Attempt colonoscopic stentingAttempt colonoscopic stenting
Cleveland Case-matched Study Cleveland Case-matched Study Obese vs NonobeseObese vs Nonobese
Dis Colon Rectum 2005; 48: 975–981
ConversionsConversions
Dis Colon Rectum 2005; 48: 975–981
Conversion rate: 30 %
German Laparoscopic German Laparoscopic Colorectal Surgery Study groupColorectal Surgery Study group
BMI 30-35 BMI>35
Conversion rate and length of operation correlate with degree of obesitySame outcomes
OBES SURG (2008) 18:66–70
Is every obese patient the Is every obese patient the same?same?
On whom would you prefer to operate ?
Japanese studyJapanese study
Visceral Obesity vs BMIVisceral Obesity vs BMI BMI readily available anthropometric BMI readily available anthropometric
indexindex BMI does not tell you anything about BMI does not tell you anything about
body fat depositsbody fat deposits Visceral obesity predictor of metabolic Visceral obesity predictor of metabolic
syndromesyndrome Half of nonobese pts by BMI have Half of nonobese pts by BMI have
visceral obesityvisceral obesityDCR 51: 1757–1767 (2008)
Determination of Visceral Fat Area (VFA)Visceral obesity > 130 CM2
Japanese studyJapanese study
VFA VFA NonobesNonobes
ee
(n=65)(n=65)
VFA VFA
obeseobese
(n=68)(n=68)
PP BMI BMI NonobesNonobes
ee
(n=106)(n=106)
BMI BMI
ObeseObese
(n=27)(n=27)
PP
Or TimeOr Time
(min)(min)190190 220220 0.0060.006 207207 235235 0.010.01
Hospital Hospital staystay
(days)(days)
99 10.510.5 0.0070.007 9.59.5 99 NSNS
ComplicatiComplicationon
(%)(%)
1212 3232 .006.006 2020 3030 nsns
DCR 51: 1757–1767 (2008)
ConclusionsConclusions
LAP colectomy in obese patients safe LAP colectomy in obese patients safe and feasibleand feasible
Superior postoperative outcomes Superior postoperative outcomes compared with open surgerycompared with open surgery
Maybe Higher conversion rateMaybe Higher conversion rate In experienced hands conversion does In experienced hands conversion does
not result in higher complicationsnot result in higher complications Type of obesity appears to determine Type of obesity appears to determine
ouctome more than BMIouctome more than BMI