Clin Colon Rectal Surg
DOI: 10.1055/s-0044-1786391
Review Article

Challenges and Strategies in Colorectal Surgery among Patients with Morbid Obesity

Shukri H.A. Dualeh
1   Division of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
2   Institute for Healthcare Policy & Innovation, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
,
Ryan Howard
1   Division of General Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
2   Institute for Healthcare Policy & Innovation, University of Michigan, Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
› Author Affiliations

Abstract

This chapter explores the interplay between morbid obesity and the challenges encountered in colorectal surgery. Understanding the unique considerations in preoperative and intraoperative management along with weight optimization tools such as bariatric surgery emerges as potential mitigators, demonstrating benefits in reducing colorectal cancer risk and improving perioperative outcomes. Furthermore, the pervasive stigma associated with morbid obesity further complicates patient care, emphasizing the need for empathetic and nuanced approaches. Recommendations for minimizing stigma involve recognizing obesity as a medical diagnosis, fostering respectful communication, and actively dispelling misconceptions. Colorectal surgeons are pivotal in navigating these complexities, ensuring comprehensive and tailored care for patients with morbid obesity.



Publication History

Article published online:
25 April 2024

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  • References

  • 1 Ward ZJ, Bleich SN, Cradock AL. et al. Projected U.S. State-Level Prevalence of adult obesity and severe obesity. N Engl J Med 2019; 381 (25) 2440-2450
  • 2 Colorectal Cancer Statistics | How Common Is Colorectal Cancer?. Accessed December 13, 2023 at: https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html
  • 3 Ye P, Xi Y, Huang Z, Xu P. Linking obesity with colorectal cancer: epidemiology and mechanistic insights. Cancers (Basel) 2020; 12 (06) 1408
  • 4 Wahl TS, Patel FC, Goss LE, Chu DI, Grams J, Morris MS. The obese colorectal surgery patient: surgical site infection and outcomes. Dis Colon Rectum 2018; 61 (08) 938-945
  • 5 Phelan SM, Burgess DJ, Yeazel MW, Hellerstedt WL, Griffin JM, van Ryn M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev 2015; 16 (04) 319-326
  • 6 Gudzune KA, Bennett WL, Cooper LA, Bleich SN. Patients who feel judged about their weight have lower trust in their primary care providers. Patient Educ Couns 2014; 97 (01) 128-131
  • 7 Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int J Obes 2013; 37 (04) 612-619
  • 8 Seibert RG, Hanchate AD, Berz JP, Schroy III PC. National disparities in colorectal cancer screening among obese adults. Am J Prev Med 2017; 53 (02) e41-e49
  • 9 Krishnamurty DM, Blatnik J, Mutch M. Stoma complications. Clin Colon Rectal Surg 2017; 30 (03) 193-200
  • 10 Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis 2010; 12 (10) 958-964
  • 11 Carlsson E, Fingren J, Hallén A-M, Petersén C, Lindholm E. The Prevalence of ostomy-related complications 1 year after ostomy surgery: a prospective, descriptive, clinical study. Ostomy Wound Manage 2016; 62 (10) 34-38
  • 12 Park J, Rivard SJ, Maguire L, Varlamos C, Duby A, Hendren S. Parastomal hernia rates and exercise after ostomy surgery. Dis Colon Rectum 2023; 66 (06) 823-830
  • 13 Beck SJ. Stoma issues in the obese patient. Clin Colon Rectal Surg 2011; 24 (04) 259-262
  • 14 Veldkamp R, Kuhry E, Hop WCJ. et al; COlon cancer Laparoscopic or Open Resection Study Group (COLOR). Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 2005; 6 (07) 477-484
  • 15 Bonjer HJ, Deijen CL, Abis GA. et al; COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med 2015; 372 (14) 1324-1332
  • 16 Stevenson ARL, Solomon MJ, Lumley JW. et al; ALaCaRT Investigators. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 2015; 314 (13) 1356-1363
  • 17 Unruh KR, Bastawrous AL, Kaplan JA, Moonka R, Rashidi L, Simianu VV. The impact of obesity on minimally invasive colorectal surgery: a report from the Surgical Care Outcomes Assessment Program collaborative. Am J Surg 2021; 221 (06) 1211-1220
  • 18 Panteleimonitis S, Popeskou S, Harper M. et al. Minimally invasive colorectal surgery in the morbid obese: does size really matter?. Surg Endosc 2018; 32 (08) 3486-3494
  • 19 Balentine CJ, Marshall C, Robinson C. et al. Obese patients benefit from minimally invasive colorectal cancer surgery. J Surg Res 2010; 163 (01) 29-34
  • 20 Jayne D, Pigazzi A, Marshall H. et al. Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 2017; 318 (16) 1569-1580
  • 21 Howard R, Chao GF, Yang J. et al. Comparative safety of sleeve gastrectomy and gastric bypass up to 5 years after surgery in patients with severe obesity. JAMA Surg 2021; 156 (12) 1160-1169
  • 22 Arterburn DE, Telem DA, Kushner RF, Courcoulas AP. Benefits and risks of bariatric surgery in adults: a review. JAMA 2020; 324 (09) 879-887
  • 23 Robertson AGN, Wiggins T, Robertson FP. et al. Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg 2021; 108 (08) 892-897
  • 24 Almazeedi S, El-Abd R, Al-Khamis A, Albatineh AN, Al-Sabah S. Role of bariatric surgery in reducing the risk of colorectal cancer: a meta-analysis. Br J Surg 2020; 107 (04) 348-354
  • 25 Afshar S, Kelly SB, Seymour K, Lara J, Woodcock S, Mathers JC. The effects of bariatric surgery on colorectal cancer risk: systematic review and meta-analysis. Obes Surg 2014; 24 (10) 1793-1799
  • 26 Bailly L, Fabre R, Pradier C, Iannelli A. Colorectal cancer risk following bariatric surgery in a nationwide study of french individuals with obesity. JAMA Surg 2020; 155 (05) 395-402
  • 27 Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease - PubMed. Accessed December 20, 2023 at: https://pubmed-ncbi-nlm-nih-gov.proxy.lib.umich.edu/31613968/
  • 28 Hussan H, Stanich PP, Gray II DM. et al. Prior bariatric surgery is linked to improved colorectal cancer surgery outcomes and costs: a propensity-matched analysis. Obes Surg 2017; 27 (04) 1047-1055
  • 29 McKechnie T, Lee Y, Hong D. et al. A history of bariatric surgery before surgery for colorectal cancer may improve short-term postoperative outcomes: analysis of the national inpatient sample 2015-2019. Surgery 2023; 174 (05) 1168-1174
  • 30 Delaney LD, Howard R, Palazzolo K. et al. Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients. JAMA Netw Open 2021; 4 (11) e2130016
  • 31 Lee Y, Raveendran L, Lovrics O. et al. The role of bariatric surgery on kidney transplantation: a systematic review and meta-analysis. Can Urol Assoc J 2021; 15 (10) E553-E562
  • 32 Shaughness G, Howard R, Englesbe M. Patient-centered surgical prehabilitation. Am J Surg 2018; 216 (03) 636-638
  • 33 Howard R, Yin YS, McCandless L, Wang S, Englesbe M, Machado-Aranda D. Taking control of your surgery: impact of a prehabilitation program on major abdominal surgery. J Am Coll Surg 2019; 228 (01) 72-80
  • 34 Alabduljabbar K, le Roux CW. Pharmacotherapy before and after bariatric surgery. Metabolism 2023; 148: 155692
  • 35 Holderbaum M, Casagrande DS, Sussenbach S, Buss C. Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review. Surg Obes Relat Dis 2018; 14 (02) 237-244
  • 36 McGrath A, Porrett T, Heyman B. Parastomal hernia: an exploration of the risk factors and the implications. Br J Nurs 2006; 15 (06) 317-321
  • 37 Khan MTA, Patnaik R, Hausman-Cohen L. et al. Obesity stratification predicts short-term complications after parastomal hernia repair. J Surg Res 2022; 280: 27-34
  • 38 Howard R, Rob F, Thumma J. et al. Contemporary outcomes of elective parastomal hernia repair in older adults. JAMA Surg 2023; 158 (04) 394-402
  • 39 Ginsburg BM, Sheer AJ. Destigmatizing obesity and overcoming inherent barriers to obtain improved patient engagement. In: StatPearls. StatPearls Publishing; 2023. Accessed December 18, 2023 at: http://www.ncbi.nlm.nih.gov/books/NBK578197/
  • 40 CDC. Obesity is a Common, Serious, and Costly Disease. Centers for Disease Control and Prevention. Published July 20, 2022. Accessed December 7, 2023 at: https://www.cdc.gov/obesity/data/adult.html
  • 41 Overweight & Obesity Statistics—NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed December 7, 2023 at: https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity
  • 42 CDC. Racism and Health. Centers for Disease Control and Prevention. Published August 16, 2023. Accessed December 22, 2023 at: https://www.cdc.gov/minorityhealth/racism-disparities/impact-of-racism.html
  • 43 Dixon JB. Regional differences in the coverage and uptake of bariatric-metabolic surgery: a focus on type 2 diabetes. Surg Obes Relat Dis 2016; 12 (06) 1171-1177
  • 44 Rubino F, Puhl RM, Cummings DE. et al. Joint international consensus statement for ending stigma of obesity. Nat Med 2020; 26 (04) 485-497
  • 45 Wear D, Aultman JM, Varley JD, Zarconi J. Making fun of patients: medical students' perceptions and use of derogatory and cynical humor in clinical settings. Acad Med 2006; 81 (05) 454-462
  • 46 Maes HH, Neale MC, Eaves LJ. Genetic and environmental factors in relative body weight and human adiposity. Behav Genet 1997; 27 (04) 325-351
  • 47 Arble DM, Bass J, Laposky AD, Vitaterna MH, Turek FW. Circadian timing of food intake contributes to weight gain. Obesity (Silver Spring) 2009; 17 (11) 2100-2102
  • 48 Heindel JJ, Newbold R, Schug TT. Endocrine disruptors and obesity. Nat Rev Endocrinol 2015; 11 (11) 653-661