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Obesity should not influence the management of appendicitis



Obesity implies an adverse effect on outcome after appendectomy. This study aimed to determine whether obese patients with appendicitis should be managed differently than nonobese patients.


After appendectomy, all patients were enrolled in a prospective clinical pathway and followed from initial presentation to full outpatient recovery.


In 1 year, 272 adults underwent appendectomy, 55 (22%) of whom were obese. The obese patients were slightly older (35 vs 33 years; p < 0.001). The time to diagnosis (8.5 vs 8.6 h), and the need for computed tomography (CT) scanning (40% vs 49%) was similar in both populations. The obese patients had similar rates of perforation (35% vs 35%) and laparoscopy (47% vs 41%). The median hospital length of stay (LOS) (2 days) and complications, including wound complications (9.1% vs 10.9%) and intraabdominal abscesses (3.6% vs 3.1%), were similar. Subgroup analysis showed a longer LOS for the obese patients with perforation than for the nonobese patients (6 vs 5.5 days; p = 0.036).


Obese patients had no greater delay in diagnosis, had no greater need for CT scan, gained no additional benefit from laparoscopy, and did not incur significantly worse outcomes after appendectomy except for an increased LOS among those with perforation.

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  1. 1.

    Ogden CL et al (2006) Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:1549–1555

  2. 2.

    Mehran A, Liberman M, Rosenthal R, Szomstein S (2003) Ruptured appendicitis after laparoscopic Roux-en-y gastric bypass: pitfalls in dignosing a surgical abdomen in the morbidly obese. Obes Surg 13:938–940

  3. 3.

    Uppot RN, Sahani DV, Hahn PF, Kalra MK, Saini SS, Mueller PR (2006) Effect of obesity on image quality: fifteen-year longitudinal study for evaluation of dictated radiology reports. Radiology 240:435–439

  4. 4.

    DeMaria EJ, Carmody BJ (2005) Perioperative management of special populations: obesity. Surg Clin North Am 85:1283–1289

  5. 5.

    Abir F, Bell R (2004) Assessment and management of the obese patient. Crit Care Med 32(4 Suppl):S87–S91

  6. 6.

    Anaya DA, Dellinger PE (2006) The obese surgical patient: a susceptible host for infection. Surg Infect 7:473–480

  7. 7.

    Dindo D, Muller MK, Weber Markus, Clavien P-A (2003) Obesity in general elective surgery. Lancet 361:2032–2035

  8. 8.

    Pessaux P, Msika S, Atalla D et al (2003) Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4,718 patients. Arch Surg 138:314–324

  9. 9.

    Birkmeyer NJ, Charlesworth DC, Hernandez F et al (1998) Obesity and risk of adverse outcomes associated with coronary artery bypass surgery. Northern New England Cardiovascular Disease Study Group. Circulation 97:1689–1694

  10. 10.

    Benoist S, Panis Y, Alves A, Valleur P (2000) Impact of obesity on surgical outcomes after colorectal resection. Am J Surg 179:275–281

  11. 11.

    Novitsky YM, Cobb WS, Kercher KW et al (2006) Laparoscopic ventral hernia repair in obese patients: a new standard of care. Arch Surg 141:57–61

  12. 12.

    Phillips EH, Carroll BJ, Fallas MJ, Pearlstein AR (1994) Comparison of laparoscopic cholecystectomy in obese and nonobese patients. Am Surg 60:316–321

  13. 13.

    Miles RH, Carballo RE, Prinz RA et al (1992) Laparoscopy: the preferred method of cholecystectomy in the morbidly obese. Surgery 112:818–823

  14. 14.

    Sauerland S, Lefering R, Neugebauer EAM (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD001546.pub2, October 18, 2004

  15. 15.

    Stoltzing H, Thon K (2000) Perforated appendicitis: is laparoscopic operation advisable? Dig Surg 17:610–616

  16. 16.

    Enochsson L, Hellberg A, Rudberg C et al (2001) Laparoscopic vs open appendectomy in overweight patients. Surg Endosc 15:387–392

  17. 17.

    Bochicchio GV, Joshi M, Bochicchio K, Nehman S, Tracy JK, Scalea TM (2006) Impact of obesity in the critically ill trauma patient: a prospective study. J Am Coll Surg 203:533–538

  18. 18.

    Towfigh S, Chen F, Mason R, Katkhouda N, Chan L, Berne T (2006) Laparoscopic appendectomy significantly reduces length of stay for perforated appendicitis. Surg Endosc 20:495–499

  19. 19.

    Katkhouda N, Mason RJ, Towfigh S, Gevorgyan A, Essani R (2005) Laparoscopic vs open appendectomy: a prospective randomized double-blind study. Ann Surg 242:439–448

  20. 20.

    Tzovaras G, Liakou P, Baloyiannis I et al (2007) Laparoscopic appendectomy: differences between male and female patients with suspected acute appendicitis. World J Surg 31:409–413

  21. 21.

    Liu S-I, Siewert B, Raptopoulos B, Hodin RA (2002) Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy. J Am Coll Surg 194:298–305

  22. 22.

    Mendez-Luck CA, Yu H, Meng YY, Jhawar M, Wallace SP (2005, April) Too many California adults are tipping the scales at an unhealthy weight. Policy brief. UCLA Center for Health Policy Research, Los Angeles

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Author information

Correspondence to S. Towfigh.

Additional information

Presented as an oral poster at the Pacific Coast Surgical Association annual meeting in Kona, Hawaii, USA, 25 February 2007.

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Towfigh, S., Chen, F., Katkhouda, N. et al. Obesity should not influence the management of appendicitis. Surg Endosc 22, 2601–2605 (2008).

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  • Appendectomy
  • Appendicitis
  • Laparoscopy
  • Morbidity
  • Obesity
  • Perforated appendicitis