The Impact of Obesity on Colorectal Surgery: A Survey of Canadian Surgeons

BACKGROUND: Over 1.7 billion adults worldwide are considered overweight or obese, with the prevalence of obesity in Canada increasing rapidly. Obesity has been shown to affect surgical outcomes such as local recurrence of cancer and wound infections following colorectal surgery. The objective of this study was to determine the perception/attitudes of Canadian surgeons toward the impact of obesity on the practice of colorectal surgery. METHODS: A twenty-question survey was administered to Canadian surgeons through mail and email solicited via the Canadian Association of General Surgeons over a period of 2010-2011. The questions focused on surgeon demographics, experience with laparoscopic colon resections and their perception of the impact of obesity toward surgical proficiency and complications. RESULTS: One hundred seventy-seven Canadian surgeons completed the survey. There was a wide range of experience among surgeons in terms of years of practice and number of colon resections performed per year. The majority (72.9%) reported having primary general surgical training. A majority of surgeons (57.7%) identified obesity as a risk factor for colorectal surgery. Furthermore, a majority agreed that obesity is a risk factor for wound infection (97.2%), stomal retraction (90.4%) and stomal herniation (82.5%). While obesity was not considered a contraindication to laparoscopic colon surgery, it was considered to increase operative time (98.3%), cardiovascular (80.2%) and respiratory (95.4%) complications. CONCLUSION: The majority of surgeons across Canada believe obesity is a risk factor for post-operative complications following laparoscopic colorectal surgery. However, the majority did not consider obesity a contraindication for laparoscopic colon resection. Surgical and peri-operative colorectal protocols may need to be re-assessed to identify methods to manage the obese patient more effectively.