Abdominal fat ratio – a novel parameter for predicting conversion in laparoscopic colorectal surgery

INTRODUCTION Laparoscopic surgery has become the standard for colorectal cancer resection in the UK but it can be technically challenging in patients who are obese. Patients whose body fat is mainly inside the abdominal cavity are more challenging than those whose fat is mainly outside the abdominal cavity. Abdominal fat ratio (AFR) is a simple parameter proposed by the authors to aid identification of this subgroup. MATERIALS AND METHODS All 195 patients who underwent elective, laparoscopic colorectal cancer resections from March 2010 to November 2013 were included in the study. For patients who were obese (body mass index greater than 30), preoperative staging computed tomography was used to determine AFR. This was assessed by two different, blinded observers and compared with conversion rate. RESULTS Of the 195 patients, 58 (29.7%) fell into the obese group and 137 (70.3%) into the non-obese group. The median AFR of the obese group that were converted to open surgery was significantly higher at 5.9 compared with those completed laparoscopically (3.3, P = 0.0001, Mann-Whitney). There was no significant difference in conversion rate when looking at body mass index, tumour site or size. DISCUSSION Previous studies have found body mass index, age, gender, previous abdominal surgery, site and locally advanced tumours to be associated with an increased risk of conversion. This study adds AFR to the list of risk factors. CONCLUSION AFR is a simple, reproducible parameter which can help to predict conversion risk in obese patients undergoing colorectal cancer resection.

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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

ANZ Journal of Surgery ◽

10.1111/ans.17227 ◽

2021 ◽

Author(s):

Ju Yong Cheong ◽

Christopher John Young ◽

Christopher Byrne

Keyword(s):

Colorectal Cancer ◽

Body Mass Index ◽

Lymph Node ◽

Body Mass ◽

The Body ◽

Operative Approach ◽

Lymph Node Yield ◽

Cancer Resection ◽

Colorectal Cancer Resection ◽

Node Yield

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The impact of obesity on perioperative and postoperative outcomes after elective endovascular abdominal aortic aneurysm repair

Vascular ◽

10.1177/17085381211063316 ◽

2021 ◽

pp. 170853812110633

Author(s):

Selami Gurkan ◽

Ozcan Gur ◽

Ayhan Sahin ◽

Mehmet Donbaloglu

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Endovascular Aneurysm Repair ◽

Group Versus ◽

Obese Group ◽

Obese Patients ◽

Dose Area Product ◽

Aneurysm Repair ◽

The Impact

Background Obesity is a common and growing health problem in vascular surgery patients, as it is in all patient groups. Evidence regarding body mass index (BMI) on endovascular aneurysm repair (EVAR) outcomes is not clear in the literature. We aimed to determine the impact of obesity on perioperative and midterm outcomes of elective EVAR between obese and non-obese patients. Methods Under a retrospective study design, a total of 120 patients (109 males, 11 females, mean age: 74.45 ± 8.59 (53–92 years)) undergoing elective EVAR between June 2012 and May 2020 were reviewed. Patients were stratified into two groups: obese (defined as a body mass index (BMI) ≥ 30 kg/m2) and non-obese (mean BMI < 30 kg/m2 (32.25 ± 1.07 kg/m2 vs 25.85 ± 2.69 kg/m2)). Results Of the 120 patients included in the study, 81 (67.5%) were defined as “nonobese,” while 39 (32.5%) were obese. The mean BMI of the study group was 27.93 ± 3.78 kg/m2. In obese patients, the procedure time, fluoroscopy time, and dose area product (DAP) values were longer than those of non-obese patients: 89.74 ± 20.54 vs 79.69 ± 28.77 min ( p = 0.035), 33.23 ± 10.14 vs 38.17 ± 8.61 min ( p = 0.01) and 133.69 ± 58.17 vs 232.56 ± 51.87 Gy.cm2 ( p < 0.001). Although there was no difference in sac shrinkage at 12-month follow-up, there was a significant decrease at 6-month follow-up in both groups ( p = 0.017). Endoleak occurred in 17.9% ( n = 7) of the obese group versus 11.1% ( n = 9) of the non-obese group ( p = 0.302). Iliac branch occlusion developed in four patients, 3 (3.7%) in the non-obese group and 1 (2.6%) in the obese group ( p = 0.608). The all-cause mortality rate was slightly higher in the obese group; however, it did not differ between the groups ( p = 0.463). Conclusion In addition to the longer procedure times, fluoroscopy times, and DAP values in obese patients, regardless of obesity, significant sac shrinkage in the first 6 months of follow-up was observed in both groups. No difference was documented with regards to mortality or morbidity following EVAR.

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Acute Bowel Obturation: Treatment Outcomes

Creative Surgery and Oncology ◽

10.24060/2076-3093-2021-11-1-15-19 ◽

2021 ◽

Vol 11 (1) ◽

pp. 15-19

Author(s):

A. L. Charyshkin ◽

E. A. Keshyan

Keyword(s):

Colorectal Cancer ◽

Body Mass Index ◽

Treatment Outcomes ◽

Body Mass ◽

Skin Irritation ◽

Skin Lesions ◽

The Body ◽

Obese Patients ◽

Two Stage ◽

Faecal Leakage

Background. Two-stage colostomy is a common choice in treatment for obstruction-complicated colorectal cancer.Aim. Research into paracolostomy complications in obese and non-obese patients.Materials and methods. Material on obstruction-complicated colorectal cancer was collected from 50 patients divided into two cohorts by the body mass index (BMI). Cohort 1 contained 25 patients with BMI <24, and cohort 2 — patients with BMI >30.Results. Compared to cohort 1 with BMI <24, obese cohort 2 revealed more paracolostomy complications, the increase in parastomal skin lesions by 32% (p < 0.05), pyoinflammatory complications by 36% (p < 0.05) and abscesses by 24% (p < 0.05).Discussion. Paracolostomy complications in patients with BMI >30 are due to obesity, a poorly fitting colostomy bag, faecal leakage, skin irritation, infection and crude coagulation in haemostasis. Stoma gradually becomes difficult to visualise, faecal leakage continues and the paracolostomy space is poorly drained in obese patients, contributing to pyoinflammatory parastomal complications.Conclusion. The main causes of pyoinflammatory parastomal complications in obese patients are a low stoma positioning and poor paracolostomy drainage. The circumstances described warrant improvement of colostomy techniques in obese patients.

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Comparison of the effectiveness of venous thromboembolism prophylaxis with enoxaparin between obese and non-obese patients

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218760159 ◽

2018 ◽

Vol 25 (4) ◽

pp. 813-817 ◽

Cited By ~ 3

Author(s):

Abdelmajid H Alnatsheh ◽

Robert D Beckett ◽

Stacy Waterman

Keyword(s):

Body Mass Index ◽

Venous Thromboembolism ◽

Body Mass ◽

Hospitalized Patients ◽

Obese Group ◽

Obese Patients ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Significant Difference ◽

Group 2

Objective The purpose of this study is to compare the incidence of venous thromboembolism between obese and non-obese hospitalized patients who received United States Food and Drug Administration-approved prophylactic enoxaparin doses and to describe enoxaparin dosing strategies used in obese patients. Methods This was a retrospective cohort study including patients who were admitted to Parkview Regional Medical Center, Parkview Hospital, or Parkview Orthopedic Hospital between September 2011 and August 2012 and received at least one dose of enoxaparin 30 mg twice daily or enoxaparin 40 mg once daily for venous thromboembolism prophylaxis. Patients classified based on their body mass index into three groups, Group 1 (non-obese: body mass index < 25 kg/m2), Group 2 (overweight: body mass index ≥ 25 kg/m2 but < 30 kg/m2), and Group 3 (obese: body mass index ≥ 30 kg/m2). The primary endpoint was venous thromboembolism occurrence within 90 days, considering day 1 of hospitalization as day 1. Results Of the 428 patients included, 8 cases of venous thromboembolism (1.9%) were identified; 3 in the non-obese group, 2 in the overweight group, and 3 in the obese group, no statistically significant differences were found between the three groups, p = 0.81. When venous thromboembolism incidence was adjusted for age and sex, no statistically significant differences were found between overweight (OR = 0.685; 95% CI 0.115–4.095), obese (OR = 0.797; 95% CI 0.353–1.796), and combined overweight and obese (OR = 0.656; 95% CI 0.154–2.799) groups compared to patients with normal body weight. Conclusion This study did not find a statistically significant difference in venous thromboembolism incidence between obese, overweight, and non-obese hospitalized patients receiving approved enoxaparin prophylaxis doses.

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Correlation of Body Mass Index and Spread of Spinal block in Herniorrhaphy Patients Under Spinal Anesthesia

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v5i1.739 ◽

2019 ◽

Author(s):

Hamzeh Hosseinzadeh ◽

Dawood Aghamohammadi ◽

Marzieh Marahem ◽

Negin Magsumi ◽

Parisa Hosseinzadeh

Keyword(s):

Body Mass Index ◽

Spinal Anesthesia ◽

Body Mass ◽

Motor Block ◽

Operation Time ◽

Sensory Block ◽

Obese Group ◽

Spinal Block ◽

Obese Patients ◽

Prick Test

Background: The level and time block in patients undergoing spinal anesthesia are affected by a variety of demographic factors (e.g., age, gender, height, weight, body mass index [BMI] and the amount of cerebrospinal fluid). Although the influence of BMI in spinal anesthesia is still a matter of controversy, the aim of this study was to determine the relationship between BMI and time of spinal block anesthesia in herniorrhaphy patients. Methods: One hundred and eighty patients, who had undergone an inguinal herniorrhaphy operation, were divided into two groups—obese (BMI ≥30kg/m2) and non-obese (BMI<30kg/m2). Demographic characteristics, operation time, anesthesia time, time sensory and motor block and changes in hemodynamics were compared between the two groups. The evaluation of spinal block height was recorded with the help of a pin-prick test and Bromage Scale after the administration of bupivacaine. Results: Body weight, height and BMI showed significant differences in the two groups and the time to reach sensory block T10 was significantly shorter in the group of obese patients. The time for recovery of sensory and motor block was longer in the obese group than in the non-obese group. Moreover, there were differences in the pattern of blood pressure of the two groups during surgery. Conclusion: The results of this study showed a correlation between BMI and the time of spinal block anesthesia. Furthermore, the maximum motor and sensory block specified in obese patients happens faster and the analgesic duration could be prolonged in patients with a higher BMI.

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