Colon and Rectal Surgery in the Obese Patient

This issue of Clinics in Colon and Rectal Surgery focuses our attention on the implications of obesity for the practicing general and colon rectal surgeon. The obese patient poses many challenges ranging from optimizing co-morbid conditions prior to surgery, technical issues in the operating room, to postoperative care. The obese patient requires greater thought, planning, and effort to ensure successful outcomes. However, obesity does not merely represent a physical characteristic but a condition which we now understand increases the risk of tumorigenesis and colorectal cancer, may influence disease activity of inflammatory bowel disease, and may affect the clinical presentation of diverticulitis. The fact that in the U.S. and other industrialized nations nearly one third of patients present with BMI >30, and with childhood obesity rates increasing, the impact of this condition on colon rectal disease and its management must be of great concern for those who are caring for these patients.

Increased interest in this topic has resulted in numerous recent contributions to the scientific literature but clearly much work remains and many questions remain yet unanswered. Our contributing authors, therefore, should be commended for accepting the challenge of reviewing the current available literature to address the topic of colon and rectal surgery in the obese patient.

Dr. Bard Cosman and Ms Yarah Haidar frame the discussion by providing an excellent overview of the epidemiology of the worldwide obesity epidemic and the magnitude of this societal problem confronting us.

Next, Drs. Nell Maloney Patel and Manish Patel discuss the common comorbid medical conditions associated with obesity and the preoperative evaluation and optimization of the obese surgical patient. Drs. Jeremy Dority, Zaki-Udin Hassan, and Destiny Chau address anesthesia in the obese patient—anatomic, physiologic, and pharmacologic issues—and specifically address laparoscopy and pneumoperitoneum in the obese patient.

We then explore the relationship between obesity and specific colon rectal diseases. Drs. Irena Gribovskaja-Rupp, Lauren Kosinski, and Kirk Ludwig examine the role obesity plays in tumorigenesis and address colorectal cancer management and outcomes in the obese patient. Drs. Marylise Boutros and David Maron, from the Cleveland Clinic Florida, highlight the emerging role that obesity plays in the development and behavior of inflammatory bowel disease and also review the surgical treatment of Crohn's disease and ulcerative colitis in the obese patient. Drs. Eric Johnson and Bradley Champagne discuss the topic of diverticulitis in the obese patient and specific issues regarding its disease behavior and the surgical options for treatment.

In regard to operative technique and the obese patient, Dr. Sandra Beck reviews the challenge of stoma creation in the obese patient. Drs. Sean Martin and Luca Stocchi examine feasibility and outcomes of the laparoscopic colectomy in the obese patient.

Last, but not least, postoperative outcomes are addressed by Drs. Timothy Geiger and Roberta Muldoon, who examine morbidity and mortality following colon rectal surgery in the obese patient, and by Dr. Jon Hourigan, who reviews the topic of obesity and surgical site infection.

Unfortunately, what is blatantly absent from this issue is an examination of obesity and anorectal disease. Somewhat inexplicably, this has not been studied to any great degree and the scientific literature is lacking. Undoubtedly, this represents opportunity for future study. Obesity has emerged as a pivotal societal health problem and it is rapidly increasing in our population. Therefore, it behooves us to explore the manner by which it influences the diseases our patients suffer from and confront the specific challenges of colon rectal surgery in the obese patient.

I sincerely thank all the authors for their excellent contributions to this issue of Clinics in Colon and Rectal Surgery.