Colorectal Unit, Surgery Department, Clinica Las Condes, Lo Fontecilla 441, 7550000, Santiago, Chile,
Surg Endosc. 2014 Jul;28(7):2090-6. doi: 10.1007/s00464-014-3440-y. Epub 2014 Feb 1.
Laparoscopic colorectal surgery (LCRS) has several advantages over open surgery, but LCRS has been associated with a higher rate of postoperative complications (POCs) among obese patients [body mass index (BMI), ≥30 kg/m(2)]. The prevalence of obesity in Chile is increasing, up to 25.1% in 2010, suggesting that a higher percentage of patients undergoing LCRS will be obese. This study compared POC rates between obese and nonobese patients undergoing LCRS.
This study included case and control patients in a prospectively maintained LCRS database who underwent LCRS between July 2007 and June 2012 at Clinica Las Condes, Santiago, Chile. Obese and nonobese (BMI <30 kg/m(2)) patients were paired by gender, age, American Society of Anesthesiologists class, preoperative diagnosis, and type of surgery. Intraoperative complications and POCs were documented up to 30 days. The severity of each POC was classified by Clavien-Dindo score.
In this study, 449 patients who underwent LCRS during the study period were identified. The study paired 53 obese patients (mean BMI 33.1 kg/m(2)) with 53 nonobese patients (mean BMI 25.9 kg/m(2)). The median age was 55 years in the obese group and 57 years in the nonobese group, and 60% of the patients in both groups were men. The findings showed POCs in 13 obese (24.5%) and 15 nonobese (28.3%) patients (p = 0.66). Stratified by severity of POCs, the two groups were similar (p = 0.62). The two groups did not differ in terms of the median time to the first feeding (1 day each) or the hospital length of stay (4 days each). Similar percentages of patients in the two groups required reoperation (p = 0.4), intensive care unit (ICU) admission (p = 0.77), and readmission to the hospital (p = 0.65) because of POCs.
The frequency of POCs after LCRS was no higher among the obese patients than among the nonobese patients.
腹腔镜结直肠手术（LCRS）相对于开放手术具有多种优势，但在肥胖患者中，LCRS 术后并发症（POC）的发生率较高[体重指数（BMI）≥30 kg/m（2）]。智利肥胖症的患病率正在上升，2010 年达到 25.1%，这表明接受 LCRS 的患者中肥胖症患者的比例将会更高。本研究比较了肥胖症和非肥胖症患者在接受 LCRS 后的 POC 发生率。
本研究纳入了 2007 年 7 月至 2012 年 6 月期间在智利圣地亚哥的 Clinica Las Condes 接受 LCRS 的前瞻性维护的 LCRS 数据库中的病例对照患者。根据性别、年龄、美国麻醉医师协会（ASA）分级、术前诊断和手术类型对肥胖症和非肥胖症（BMI<30 kg/m（2））患者进行配对。记录术中并发症和术后 30 天内的 POC。通过 Clavien-Dindo 评分系统对每种 POC 的严重程度进行分类。
在这项研究中，研究期间共确定了 449 名接受 LCRS 的患者。研究将 53 名肥胖症患者（平均 BMI 为 33.1 kg/m（2））与 53 名非肥胖症患者（平均 BMI 为 25.9 kg/m（2））进行了配对。肥胖组的中位年龄为 55 岁，非肥胖组为 57 岁，两组患者中各有 60%为男性。结果显示，13 名肥胖症患者（24.5%）和 15 名非肥胖症患者（28.3%）出现 POC（p=0.66）。按 POC 严重程度分层，两组相似（p=0.62）。两组在首次进食时间（均为 1 天）或住院时间（均为 4 天）方面无差异。两组因 POC 而再次手术的患者比例相似（p=0.4）、入住重症监护病房（ICU）的患者比例相似（p=0.77）、再入院的患者比例相似（p=0.65）。
肥胖症患者接受 LCRS 后的 POC 发生率并不高于非肥胖症患者。
