Is the NICE procedure the great equalizer for patients with high BMI undergoing resection for diverticulitis?

By 2030, projections indicate that nearly half of USS adults will be obese, with 29 states exceeding a 50% obesity rate. High Body Mass Index (BMI) presents particular challenges in treating diverticulitis, including worsened symptoms and increased risk of surgical complications. The Robotic Natural orifice Intracorporeal Anastomosis with Transrectal Extraction (NICE) procedure has been developed for colorectal surgeries to tackle these challenges. This study evaluates the efficacy of the Robotic NICE procedure in achieving comparable surgical outcomes in patients with both high and normal BMI.

This retrospective cohort study assessed the outcomes of robotic-assisted colectomy utilizing the NICE technique in patients with diverticulitis, dividing them into two groups based on BMI: high BMI (≥ 30 kg/m^2) and non-high BMI (< 30 kg/m^2).

Among the 194 patients analyzed, the incidence of complicated diverticulitis was significantly higher in the high BMI group (60.5%) compared to the non-high BMI group (39%; p = 0.003).The high BMI group had higher ASA scores, indicating sicker patients. The high BMI group also had a significantly higher rate of unplanned operations within 30 days (7.9% vs. 1.7%, p = 0.034). However, no significant differences were observed in the length of hospital stay, time to first flatus, or ICU admission rates between the two groups. Binary logistic regression highlighted the length of stay as a significant predictor of postoperative complications (Odds Ratio: 1.9686, 95% CI: 1.372-2.825, p < 0.001). Other factors, including age, operative time, and gender, did not significantly predict complications.

The findings suggest that the Robotic NICE procedure can mitigate some of the challenges typically associated with conventional minimally invasive surgery in which abdominal wall incision is made, providing consistent outcomes regardless of BMI. Further research is needed to explore long-term benefits, aiming to establish this approach as a standard for managing diverticulitis in our patient population.