TY - JOUR
T1 - Laparoscopic colectomy in obese patients
T2 - a comparison of laparoscopic and hand-assisted laparoscopic techniques
AU - Overbey, Douglas M.
AU - Cowan, Michelle L.
AU - Hosokawa, Patrick W.
AU - Chapman, Brandon C.
AU - Vogel, Jon D.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients. Methods: The ACS-NSQIP public use file and targeted colectomy dataset, 2012-2014, were utilized for patients undergoing colectomy and LAR. Only obese patients (BMI > 30) and laparoscopic or hand-assisted operations were included. Patient, operation, and outcome variables were compared in two separate cohorts: colectomy and LAR. Bivariate analysis compared the approaches, followed by multivariable regression. Results: Of 9610 obese patients included, HAL and LAP colectomy were performed in 3126 and 3793 patients and LAR in 1431 and 1260 patients, respectively. In comparison to LAP colectomy, HAL colectomy patients had increased comorbidities including class 2 and 3 obesity. HAL colectomy was associated with higher overall morbidity (20 vs. 16%, p < 0.001), infectious complications (10.2 vs. 7.7%, p < 0.001), anastomotic leaks (3.0 vs. 2.2%, p = 0.03), and ileus (11 vs. 8%, p < 0.001). Multivariate analysis indicated that overall morbidity (OR 1.27, 95% CI 1.11–1.44), infectious complications (OR 1.35, 95% CI 1.14–1.59), and ileus (OR 1.33, 95% CI 1.12–1.57) were each increased in the HAL colectomy cohort but not different for HAL and LAP LAR. Conclusions: In comparison to LAP colectomy, the HAL technique is used more often in obese patients with an increased operative risk profile. While inherent bias and unmeasured variables limit the analysis, the available data indicate that the HAL technique is associated with increased perioperative morbidity. Alternatively, HAL and LAP LAR are performed in obese patients with a similar risk profile and result in similar postoperative outcomes.
AB - Background: Recent American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP)-based evidence indicates that laparoscopic (LAP) colectomy results in improved outcomes compared to hand-assisted laparoscopic (HAL) colectomy in the general population. Previous comparative studies demonstrated that the HAL technique offers distinct advantages for obese patients. The aim of this study was to perform comparative analyses of HAL and LAP colectomy and low anterior resection (LAR) in obese patients. Methods: The ACS-NSQIP public use file and targeted colectomy dataset, 2012-2014, were utilized for patients undergoing colectomy and LAR. Only obese patients (BMI > 30) and laparoscopic or hand-assisted operations were included. Patient, operation, and outcome variables were compared in two separate cohorts: colectomy and LAR. Bivariate analysis compared the approaches, followed by multivariable regression. Results: Of 9610 obese patients included, HAL and LAP colectomy were performed in 3126 and 3793 patients and LAR in 1431 and 1260 patients, respectively. In comparison to LAP colectomy, HAL colectomy patients had increased comorbidities including class 2 and 3 obesity. HAL colectomy was associated with higher overall morbidity (20 vs. 16%, p < 0.001), infectious complications (10.2 vs. 7.7%, p < 0.001), anastomotic leaks (3.0 vs. 2.2%, p = 0.03), and ileus (11 vs. 8%, p < 0.001). Multivariate analysis indicated that overall morbidity (OR 1.27, 95% CI 1.11–1.44), infectious complications (OR 1.35, 95% CI 1.14–1.59), and ileus (OR 1.33, 95% CI 1.12–1.57) were each increased in the HAL colectomy cohort but not different for HAL and LAP LAR. Conclusions: In comparison to LAP colectomy, the HAL technique is used more often in obese patients with an increased operative risk profile. While inherent bias and unmeasured variables limit the analysis, the available data indicate that the HAL technique is associated with increased perioperative morbidity. Alternatively, HAL and LAP LAR are performed in obese patients with a similar risk profile and result in similar postoperative outcomes.
KW - Colectomy
KW - Colorectal
KW - Hand-assisted
KW - Laparoscopic
KW - Obesity
UR - http://www.scopus.com/inward/record.url?scp=85014611575&partnerID=8YFLogxK
U2 - 10.1007/s00464-017-5422-3
DO - 10.1007/s00464-017-5422-3
M3 - Article
C2 - 28281115
AN - SCOPUS:85014611575
SN - 0930-2794
VL - 31
SP - 3912
EP - 3921
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 10
ER -