The risks of surgery in obese patints
Obesity is commonly considered a surgical risk factor, but the degree of risk has been imprecisely quantified. There is little evidence that excessive body weight in itself should contraindicate general surgery. However, obesity is often associated with abnormal cardiorespiratory function, metabolic function, and hemostasis, which may predispose to morbidity and mortality after surgery. We review pertinent data and offer guidelines to minimize the risks of surgery in obese patients.
Available from: Bogdan Geavlete
- "Due to the physiological changes that alter cardiac, respiratory, metabolic and haemostatic functions, obesity predisposes to co-morbidity and increased risk . Moreover, the increasing prevalence of obesity and morbid obesity suggests that the surgical treatment in these patients will become more common . "
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ABSTRACT: High-grade obesity raises some specific problems regarding the endourological approach. The aim of our study was to determine if this pathology might influence the outcome of retrograde ureteroscopy.
We evaluated the outcome of 88 ureteroscopies performed in highly obese patients during the last 5 years. The data were compared with the results of 88 consecutive ureteroscopies performed in normal weight patients.
The success rate in the study group was of 91% by comparison with 95% in the normal weight group. The use of flexible ureteroscopes was imposed in 17% of the obese group vs. 11% in the control group. The complications rate (all mild) was of 6.8% in the obese group vs. 4.5% in the normal weight patients. The differences between the two groups, although present, were not statistically significant. However, in two cases with obesity, the weight of the patients was too high for the operating table, imposing supplementary sustaining measures.
Ureteroscopic treatment of stones in obese patients is an acceptable treatment modality, with success rates similar to non-obese patients. Sometimes it may require some logistic measures in the operating theatre.
Available from: Lebron Cooper
- "Morbidly obese patients have reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity . Alveolar arterial oxygenation gradient is increased, and atelectasis has been found to persist for at least 24 hours in morbidly obese patients, whereas it disappeared in the nonobese . "
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ABSTRACT: Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications.
Available from: Wayne Michael Butler
- "An equally plausible theory is that obesity increases the technical challenge of surgery. The literature certainly supports this notion, showing higher levels of perioperative complication and increased margin positivity among patients with higher BMI  . Table 1 Clinical parameters of the study population stratified by BMI "
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ABSTRACT: Obesity has correlated with adverse pathologic features on prostate biopsy and may predispose to a higher rate of prostate cancer-related death after radical prostatectomy. In this study, we examine the potential relationship between body mass index (BMI) and histopathologic findings on transperineal template-guided mapping biopsy of the prostate (TTMB).
From January 2005 to January 2008, 244 consecutive patients underwent TTMB using an anatomic-based technique. The criteria for TTMB included previously negative transrectal ultrasound (TRUS) biopsy with persistently elevated PSA and/or diagnosis of ASAP, or HG-PIN. The study population was divided into 4 different BMI cohorts (BMI < 25, BMI 25-29.9, BMI 30-34.9, and BMI ≥ 35 kg/m(2)). Biopsy findings were compared between the various BMI cohorts using one-way analysis of variance (ANOVA) and the χ(2) test.
Pre-TTMB clinical parameters, including PSA and prostate volume, were not significantly different between the various BMI cohorts. On average, the study population had undergone 1.7 TRUS biopsies before TTMB. Of the 244 study patients, 112 (45.9%), were diagnosed with prostate adenocarcinoma on TTMB. There was no difference in the rate of cancer detection between the different BMI cohorts. Among patients diagnosed with prostate cancer, BMI did not correlate with Gleason score or percent of positive biopsy cores. When the geography of biopsy-positive cores was analyzed, there were no statistically significant differences in cancer location among the different BMI groups.
In this study, obesity did not predispose toward higher Gleason score, larger cancer volume, or geographic cancer distribution on repeat biopsy with TTMB.
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