Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Aziz, Mohamed A Abd El; Grass, Fabian; Perry, William; Behm, Kevin T.; Shawki, Sherief; Larson, David W.; Mathis, Kellie L.

doi:10.1016/j.soard.2020.06.033

Cited by 15 publications

(15 citation statements)

References 34 publications

(43 reference statements)

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“…The search strategy yielded 295 articles which were screened by title then abstract. Following this screening, 32 full‐text articles were assessed for eligibility, with eight studies included in qualitative synthesis 19–26 and five studies ultimately included in meta‐analysis 21–25 (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…Indications for operative management were for malignancy only in two studies, 20,25 whilst benign and malignant disease processes were included in six studies. All studies used a BMI cut‐off for ‘obese’ patients of 30, except for one study investigating patients with ‘super obesity’ and a corresponding BMI cut‐off of 50 19 . In total, there were 263 patients in the OB group and 400 in the NOB group forming the sample for meta‐analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Seven studies 19,21–26 reported on operating time, with three studies 22,23,25 comparing OB and NOB patients included in pooled analysis. Two studies comparing OB and NOB patients were excluded from meta‐analysis due to lack of required data.…”

Section: Resultsmentioning

confidence: 99%

“…Six articles 19,21–25 reported on overall complication rate, with all studies comparing OB and NOB patients included in pooled analysis. There was a trend towards higher overall complications in 263 OB versus 400 NOB patients (32.3% versus 26.8% respectively, pooled OR 1.42, p = 0.061).…”

Section: Resultsmentioning

confidence: 99%

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Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Wang

Johnson

Casey

et al. 2022

ANZ Journal of Surgery

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Background: Colon cancer resection can be technically difficult in the obese (OB) population. Robotic surgery is a promising technique but its benefits remain uncertain in OB patients. The aim of this study is to compare OB versus non-obese (NOB) patients undergoing robotic colon surgery, as well as OB patients undergoing robotic versus open or laparoscopic colonic surgery. Methods: A systematic review and meta-analysis was performed. Primary outcome measures included length of stay (LOS), surgical site infection (SSI) rate, complications, anastomotic leak and oncological outcomes. Results: A total of eight studies were included, with five comparing OB and NOB patients undergoing robotic colon surgery included in meta-analysis. A total of 263 OB patients and 400 NOB patients formed the sample for meta-analysis. There was no significant difference between the two groups in operative time, conversion to open, LOS, lymph node yield, anastomotic leak and postoperative ileus. There was a trend towards a significant increase in overall complications and SSI in the OB group (32.3% OB versus 26.8% NOB for complications, 14.2% OB versus 9.9% NOB for SSI). The three included studies comparing surgical techniques were too heterogeneous to undergo meta-analysis. Conclusion: Robotic colon surgery is safe in obese patients, but high-quality prospective evidence is lacking. Future studies should report on oncological safety and the costeffectiveness of adopting the robotic technique in these challenging patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Wang

Johnson

Casey

et al. 2022

ANZ Journal of Surgery

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“…This focus on minimally invasive colon and rectal cases is of particular importance given the increasing widespread utilization of MIS in the United States. 13,14…”

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confidence: 99%

Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects

Aziz

Grass

Calini

et al. 2021

Diseases of the Colon &Amp; Rectum

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BACKGROUND:The efficacy of preoperative oral antibiotics alone compared to mechanical bowel preparation and oral antibiotics in minimally invasive surgery is still a matter of ongoing debate. OBJECTIVE:This study aimed to assess the trend of surgical site infection rates in parallel to the utilization of bowel preparation modality over time for minimally invasive surgery colorectal surgeries in the United States.DESIGN: Retrospective analysis.

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Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis

Aziz

Calini

Grass

et al. 2021

Langenbecks Arch Surg

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Background Obesity is a risk factor for failure of pouch surgery completion. However, little is known about the impact of obesity on short-term outcomes after minimally invasive (MIS) ileal pouch-anal anastomosis (IPAA). This study aimed to assess shortterm postoperative outcomes in patients undergoing MIS total proctocolectomy (TPC) with IPAA in patients with and without obesity. Materials and methods All adult patients (≥ 18 years old) who underwent MIS IPAA as reported in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files 2007 to 2018 were included. Patients were divided according to their body mass index (BMI) into two groups (BMI ≥ 30 kg/m 2 vs. BMI < 30 kg/m 2 ). Baseline demographics, preoperative risk factors including comorbidities, American Society of Anesthesiologists Class, smoking, different preoperative laboratory parameters, and operation time were compared between the two groups. Propensity score matching (1:1) based on logistic regression with a caliber distance of 0.2 of the standard deviation of the logit of the propensity score was used to overcome biases due to different distributions of the covariates. Thirty-day postoperative complications including overall surgical and medical complications, surgical site infection (SSI), organ space infection, systemic sepsis, 30-day mortality, and length of stay were compared between both groups. Results Initially, a total of 2158 patients (402 (18.6%) obese and 1756 (81.4%) nonobese patients) were identified. After 1:1 matching, 402 patients remained in each group. Patients with obesity had a higher risk of postoperative organ/space infection (12.9%; vs. 6.5%; p-value 0.002) compared to nonobese patients. There was no difference between the groups regarding the risk of postoperative sepsis, septic shock, need for blood transfusion, wound disruption, superficial SSI, deep SSI, respiratory, renal, major adverse cardiovascular events (myocardial infarction, stroke, cardiac arrest requiring cardiopulmonary resuscitation), venous thromboembolism, 30-day mortality, and length of stay. Conclusion MIS IPAA can be safely performed in patients with obesity. However, patients with obesity have a 2-fold risk of organ space infection compared to patients without obesity. Loss of weight before MIS IPAA is recommended not only to allow for pouch creation but also to decrease organ space infections.

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Colectomy for patients with super obesity: current practice and surgical morbidity in the United States

Cited by 15 publications

References 34 publications

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Robotic colon surgery in obese patients: a systematic review and meta‐analysis

Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects

Minimally invasive ileal pouch-anal anastomosis for patients with obesity: a propensity score-matched analysis

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