The Impact of Obesity on Colorectal Surgery: A Survey of Canadian Surgeons

Abstract

BackgroundOver 1.7 billion adults worldwide are considered overweight or obese, with the prevalence of obesity in Canada increasing rapidly. Obesity has been shown to affect surgical outcomes such as local recurrence of cancer and wound infections following colorectal surgery. The objective of this study was to determine the perception/attitudes of Canadian surgeons toward the impact of obesity on the practice of colorectal surgery.MethodsA twenty-question survey was administered to Canadian surgeons through mail and email solicited via the Canadian Association of General Surgeons over a period of 2010-2011. The questions focused on surgeon demographics, experience with laparoscopic colon resections and their perception of the impact of obesity toward surgical proficiency and complications.ResultsOne hundred seventy-seven Canadian surgeons completed the survey. There was a wide range of experience among surgeons in terms of years of practice and number of colon resections performed per year. The majority (72.9%) reported having primary general surgical training. A majority of surgeons (57.7%) identified obesity as a risk factor for colorectal surgery. Furthermore, a majority agreed that obesity is a risk factor for wound infection (97.2%), stomal retraction (90.4%) and stomal herniation (82.5%). While obesity was not considered a contraindication to laparoscopic colon surgery, it was considered to increase operative time (98.3%), cardiovascular (80.2%) and respiratory (95.4%) complications.ConclusionThe majority of surgeons across Canada believe obesity is a risk factor for post-operative complications following laparoscopic colorectal surgery. However, the majority did not consider obesity a contraindication for laparoscopic colon resection. Surgical and peri-operative colorectal protocols may need to be re-assessed to identify methods to manage the obese patient more effectively.

Does the body mass index impact lymph node yield for colorectal cancer resection, and does operative approach influence this: a review of bi‐national colorectal cancer audit database

“…Operating on an obese patient is technically more challenging, and in patients with intra‐abdominal obesity (as opposed to abdominal wall obesity), the planes of dissection may not be as clear as those in non‐obese patients. A survey of 177 colorectal surgeons in Canada found that colorectal surgeries on obese patients were more difficult, had longer operative times, and had an increased risk of post‐surgical complications, including wound infection, stoma retractions and stoma herniations 1 . A study comparing colorectal operations in 158 obese patients with 426 non‐obese patients found that the effect of obesity on wound infection for right hemicolectomy was non‐significant.…”

“…A survey of 177 colorectal surgeons in Canada found that colorectal surgeries on obese patients were more difficult, had longer operative times, and had an increased risk of post-surgical complications, including wound infection, stoma retractions and stoma herniations. 1 A study comparing colorectal operations in 158 obese patients with 426 nonobese patients found that the effect of obesity on wound infection for right hemicolectomy was non-significant. However, for left hemicolectomy, the rate of intra-abdominal collections/abscess was significantly higher in obese patients (2% versus 10%), such that the author recommended drain insertion for obese patients.…”

“…Surgery is often more difficult in patients with intra‐abdominal obesity, as the planes of dissection are not as clear and the tissue is heavier. This results in a longer operating time and a greater risk of surgical complications, including wound infection, stoma retraction and stoma herniation 1 . In rectal cancer resection, obesity is an independent risk factor for anastomotic leakage (16% versus 6%), and it is recommended that drains be inserted after surgery in obese patients 2 .…”

Open–close case? New data on appendectomy in an obese patient cohort

“…General surgeons shared this sentiment at the time [5] and also considered obesity to be a contra indication. Interestingly, even today, 98% of Canadian surgeons believe that obesity increases operative time for colonic procedures [6].…”

Optimizing Patient Selection for Laparoscopic and Open Colorectal Cancer Resections: A National Surgical Quality Improvement Program–Matched Analysis

“…11,15,16,[23][24][25][26][27] When compared with nonobese patients, however, several studies have associated obesity with a higher risk of postoperative complications, especially anastomotic leak and wound infection. [27][28][29][30] Anastomotic leaks still represent one of the most alarming complications after colorectal resection and is hence an important complication to take into account. 31 Some studies have also suggested that potential laparoscopic technical difficulties may result in an increased rate of conversion or longer operative time.…”