Keller Deborah S, Ibarra Sergio, Flores-Gonzalez Juan Ramon, Ponte Oscar Moreno, Madhoun Nisreen, Pickron T Bartley, Haas Eric M
Colorectal Surgical Associates, Houston, TX, USA.
Division of Minimally Invasive Colon and Rectal Surgery, Department of Surgery, University of Texas Medical School at Houston, 7900 Fannin, Suite 2700, Houston, TX, 77030, USA.
Surg Endosc. 2016 Feb;30(2):739-744. doi: 10.1007/s00464-015-4268-9. Epub 2015 Jun 20.
Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS offers several patient-related benefits over multiport laparoscopy. However, its use in obese patients has been limited from concerns of technical difficulty, oncologic compromise, and higher complication and conversion rates. Our objective was to evaluate the feasibility and efficacy of SILS for colectomy in obese patients.
Review of a prospective database identified patients undergoing elective colectomy using SILS from 2009 to 2014. They were stratified into obese (BMI ≥ 30 kg/m(2)) and non-obese cohorts (BMI < 30 kg/m(2)) and then matched on patient characteristics, diagnosis, and operative procedure. Demographic and perioperative outcome data were evaluated. The primary outcome measures were operative time, length of stay (LOS), and conversion, complication, and readmission rates for each cohort.
A total of 160 patients were evaluated-80 in each cohort. Patients were well matched in demographics, diagnosis, and procedure variables. The obese cohort had significantly higher BMI (p < 0.001) and ASA scores (p = 0.035). Operative time (176.9 ± 64.0 vs. 144.4 ± 47.2 min, p < 0.001) and estimated blood loss (89.0 ± 139.5 vs. 51.6 ± 38.0 ml, p < 0.001) were significantly higher in the obese. There were no significant differences in conversion rates (p = 0.682), final incision length (p = 0.088), LOS (p = 0.332), postoperative complications (p = 0.430), or readmissions (p = 1.000) in the obese versus non-obese. Further, in malignant cases, lymph nodes harvested (p = 0.757) and negative distal margins (p = 1.000) were comparable across cohorts.
Single-incision laparoscopic colectomy in obese patients had significantly longer operative times, but comparable conversion rates, oncologic outcomes, lengths of stay, complication, and readmission rates as the non-obese cohorts. In the obese, where higher morbidity rates are typically associated with surgical outcomes, SILS may be the ideal platform to optimize outcomes in colorectal surgery. With additional operative time, the obese can realize the same clinical and quality benefits of minimally invasive surgery as the non-obese.
单孔腹腔镜手术（SILS）对于良性和恶性结直肠疾病是安全可行的。与多孔腹腔镜手术相比，SILS有一些与患者相关的优势。然而，由于担心技术难度、肿瘤根治性受损以及更高的并发症和中转开腹率，其在肥胖患者中的应用受到限制。我们的目的是评估SILS用于肥胖患者结肠切除术的可行性和疗效。
回顾一个前瞻性数据库，确定2009年至2014年期间接受SILS择期结肠切除术的患者。将他们分为肥胖组（BMI≥30kg/m²）和非肥胖组（BMI<30kg/m²），然后根据患者特征、诊断和手术方式进行匹配。评估人口统计学和围手术期结局数据。主要结局指标是每组的手术时间、住院时间（LOS）、中转开腹率、并发症发生率和再入院率。
共评估了160例患者，每组80例。患者在人口统计学、诊断和手术变量方面匹配良好。肥胖组的BMI（p<0.001）和ASA评分（p=0.035）显著更高。肥胖组的手术时间（176.9±64.0对144.4±47.2分钟，p<0.001）和估计失血量（89.0±139.5对51.6±38.0ml，p<0.001）显著更高。肥胖组与非肥胖组在中转开腹率（p=0.682）、最终切口长度（p=0.088）、LOS（p=0.332）、术后并发症（p=0.430）或再入院率（p=1.000）方面无显著差异。此外，在恶性病例中，两组的淋巴结清扫数量（p=0.757）和远端切缘阴性率（p=1.000）相当。
肥胖患者的单孔腹腔镜结肠切除术手术时间明显更长，但中转开腹率、肿瘤学结局、住院时间、并发症发生率和再入院率与非肥胖组相当。在肥胖患者中，较高的发病率通常与手术结局相关，SILS可能是优化结直肠手术结局的理想平台。尽管手术时间增加，但肥胖患者能够获得与非肥胖患者相同的微创手术临床和质量效益。
