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Purpose <p>Evidence-to-practice gaps in minimally invasive colectomy persist globally, particularly in low- and middle-income countries (LMICs), community hospitals, and resource-limited settings. This systematic review compares surgical site infection (SSI) rates following laparoscopic versus open colectomy in obese adults to provide an evidence foundation for practice standardization across diverse healthcare settings.</p> Methods <p>A systematic screening of MEDLINE, Embase, CENTRAL, PubMed, and Scopus was conducted for studies published from January 2010 onwards. The included studies consisted of obese adults with a BMI ≥ 30&#xa0;kg/m² undergoing colectomy. Both randomized and nonrandomized comparative studies were considered. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence was evaluated with GRADE.</p> Results <p>Twenty studies met inclusion criteria, representing over 250,000 colorectal surgical cases. Laparoscopic SSI rates were 4.1% versus 7.9% for open colectomy in large database studies, and 3.2% versus 7.3% in cohort studies. Narrative synthesis and meta-analyses reported 30–60% relative risk reductions in SSI with laparoscopy. Obesity remained an independent SSI risk factor (OR 1.5–2.1) across pooled analyses.</p> Conclusion <p>With moderate certainty of evidence, laparoscopic colectomy reduces SSI by 30–60% in obese adults compared to open surgery. These findings are relevant not only where laparoscopy is established, but critically to guide adoption in community hospitals, lower-volume centers, and LMICs where the evidence-to-practice gap remains consequential. Future research should address robotic colectomy in the super-obese (BMI ≥ 40&#xa0;kg/m²), standardized SSI reporting, and prospective multicenter trials in under-resourced settings.</p>

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Laparoscopic vs. open colectomy and surgical site infection in obese patients in the modern era (post-2010): a systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Ali Hussein Choker,
  • Omar Shoker,
  • Heba Owydat,
  • Leila Owydat

摘要

Purpose

Evidence-to-practice gaps in minimally invasive colectomy persist globally, particularly in low- and middle-income countries (LMICs), community hospitals, and resource-limited settings. This systematic review compares surgical site infection (SSI) rates following laparoscopic versus open colectomy in obese adults to provide an evidence foundation for practice standardization across diverse healthcare settings.

Methods

A systematic screening of MEDLINE, Embase, CENTRAL, PubMed, and Scopus was conducted for studies published from January 2010 onwards. The included studies consisted of obese adults with a BMI ≥ 30 kg/m² undergoing colectomy. Both randomized and nonrandomized comparative studies were considered. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence was evaluated with GRADE.

Results

Twenty studies met inclusion criteria, representing over 250,000 colorectal surgical cases. Laparoscopic SSI rates were 4.1% versus 7.9% for open colectomy in large database studies, and 3.2% versus 7.3% in cohort studies. Narrative synthesis and meta-analyses reported 30–60% relative risk reductions in SSI with laparoscopy. Obesity remained an independent SSI risk factor (OR 1.5–2.1) across pooled analyses.

Conclusion

With moderate certainty of evidence, laparoscopic colectomy reduces SSI by 30–60% in obese adults compared to open surgery. These findings are relevant not only where laparoscopy is established, but critically to guide adoption in community hospitals, lower-volume centers, and LMICs where the evidence-to-practice gap remains consequential. Future research should address robotic colectomy in the super-obese (BMI ≥ 40 kg/m²), standardized SSI reporting, and prospective multicenter trials in under-resourced settings.