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Is obesity a factor of surgical difficulty in transanal endoscopic surgery?

Xavier Serra-Aracil¹, Esther Gil-Barrionuevo¹, Raquel Lobato-Gil¹

¹Department of Colorectal Surgery, Department of General and Digestive Surgery, Parc Taulí University Hospital, Universidad Autonoma de Barcelona (UAB), Parc Taulí S/n, 08208, Sabadell, Barcelona, Spain.

American Journal of Surgery

|January 28, 2020

Abstract

Background:

The aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients.

Methods:

Observational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) < 30 kg/m² and BMI ≥30 kg/m², the latter defined as obese.

Results:

From 775 patients, 681 were enrolled in the study, 145 (21.3%) of them obese. No statistically significant differences between groups were found with respect to overall morbidity (27, 18.6%).The obese patients presented trends towards shorter mean surgical time (65 min, IQR 48 min), less perforation in the peritoneal cavity (eight, 5.5%), and 133 (91.7%) presented a lower rate of lesion fragmentation.

Conclusion:

There were no significant differences in postoperative outcomes in obese patients (BMI ≥30 kg/m²). TES in those obese patients does not represent a factor of surgical difficulty.

Insights

Transanal endoscopic surgery (TES) is feasible in obese patients. This study found no significant differences in postoperative outcomes for obese individuals undergoing TES, indicating it is not a factor of surgical difficulty.

Area of Science:

Colorectal Surgery
Surgical Oncology
Obesity Medicine

Background:

Transanal endoscopic surgery (TES) is a minimally invasive technique for rectal tumor removal.
Obesity is a growing concern in surgical patient populations.
Assessing the safety and efficacy of TES in obese patients is crucial.

Purpose of the Study:

To evaluate the feasibility and outcomes of transanal endoscopic surgery (TES) in patients with rectal tumors and a body mass index (BMI) of 30 kg/m² or higher.
To compare the surgical outcomes of obese patients undergoing TES with non-obese patients.

Main Methods:

An observational, descriptive study was conducted between June 2004 and January 2019.
Patients were categorized into two groups: non-obese (BMI < 30 kg/m²) and obese (BMI ≥ 30 kg/m²).
Surgical outcomes, including morbidity, operative time, and complication rates, were analyzed and compared between the groups.

Main Results:

A total of 681 patients were analyzed, with 145 (21.3%) identified as obese.
No statistically significant differences in overall morbidity were observed between obese and non-obese patients (18.6% vs. 27%).
Obese patients showed trends towards shorter surgical times, fewer instances of peritoneal cavity perforation, and a lower rate of lesion fragmentation.

Conclusions:

Transanal endoscopic surgery (TES) is a feasible surgical option for obese patients with rectal tumors.
Obesity (BMI ≥ 30 kg/m²) does not appear to be a significant factor increasing surgical difficulty or negatively impacting postoperative outcomes in TES.
The findings support the use of TES in obese individuals, suggesting comparable safety and efficacy to non-obese patients.

Read full analysis

Keywords:

Body mass index Minimally invasive surgery Obesity Rectal adenomas TEM TEO Transanal endoscopic microsurgery

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