Andrea Vignali, Paola De Nardi, Luca Ghirardelli, Saverio Di Palo, Carlo Staudacher, Department of Surgery, San Raffaele Scientific Institute, University Vita Salute, 20132 Milan, Italy.
World J Gastroenterol. 2013 Nov 14;19(42):7405-11. doi: 10.3748/wjg.v19.i42.7405.
To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal diseases.
A total of 98 obese (body mass index > 30 kg/m(2)) patients who underwent laparoscopic (LPS) right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open colectomy. Controls were selected to match for body mass index, site of primary disease, American Society of Anesthesiologists score, and year of surgery (± 3 year). The parameters analyzed included age, gender, comorbid conditions, American Society of Anaesthesiologists class, diagnosis, procedure, and duration of operation, operative blood loss, and amount of homologous blood transfused. Conversion rate, intra and postoperative complications as were as reoperation rate, 30 d and long-term morbidity rate were also analyzed. For continuous variables, the Student's t test was used for normally distributed data the Mann-Whitney U test for non-normally distributed data. The Pearson's χ(2) tests, or the Fisher exact test as appropriate, were used for proportions.
Conversion to open surgery was necessary in 13 of 98 patients (13.3%). In the LPS group, operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy (P = 0.03, P = 0.0001, respectively). Overall morbidity, anastomotic leak and readmission rate did not significantly differ between the two groups. A trend toward a reduction of wound complications was observed in the LPS when compared to open group (P = 0.09). In the LPS group, an earlier recovery of bowel function (P = 0.001) and a shorter length of stay (P = 0.03) were observed. After a median follow-up of 62 (range 12-132) mo 23 patients in the LPS group and 38 in the open group experienced long-term complications (LPS vs open, P = 0.03). Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the laparoscopic one (P = 0.03).
Laparoscopic colectomy in obese patients is safe, does not jeopardize postoperative complications and resulted in lower incidence of long-term complications when compared with open cases.
探讨腹腔镜结肠切除术对肥胖结直肠疾病患者短期和长期结局的影响。
从一个前瞻性机构批准的数据库中确定了 98 例肥胖（体重指数>30kg/m(2)）患者，他们在 10 年内接受了腹腔镜（LPS）右或左结肠切除术，并手动匹配接受开放结肠切除术的肥胖患者。对照组的选择要匹配体重指数、原发疾病部位、美国麻醉医师协会评分和手术年份（±3 年）。分析的参数包括年龄、性别、合并症、美国麻醉医师协会分级、诊断、手术过程和手术时间、手术出血量和同种异体输血量。转换率、术中及术后并发症以及再次手术率、30d 和长期发病率也进行了分析。对于连续变量，正态分布数据采用 Student's t 检验，非正态分布数据采用 Mann-Whitney U 检验。采用 Pearson's χ(2)检验或适当的 Fisher 确切概率检验进行比例分析。
98 例患者中，有 13 例（13.3%）需要转为开腹手术。与开腹手术相比，LPS 组的手术时间延长 29 分钟，出血量减少 78ml（P=0.03，P=0.0001）。两组的总发病率、吻合口漏和再入院率无显著差异。与开腹组相比，LPS 组的切口并发症发生率呈降低趋势（P=0.09）。LPS 组术后肠功能恢复更快（P=0.001），住院时间更短（P=0.03）。中位随访 62（范围 12-132）个月后，LPS 组 23 例和开腹组 38 例患者出现长期并发症（LPS 组与开腹组，P=0.03）。切口疝是最常见的长期并发症，与腹腔镜组相比，开腹组的发生率明显更高（P=0.03）。
腹腔镜结肠切除术在肥胖患者中是安全的，不会增加术后并发症的风险，与开腹手术相比，腹腔镜结肠切除术的长期并发症发生率更低。
