• Minoa Jung, Francesco Volonté, Nicolas C Buchs, Angèle Gayet-Ageron, François Pugin, Pascal Gervaz, Frederic Ris, and Philippe Morel.
• 1Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland 2CRC and Division of Clinical Epidemiology, Department of Community Health and Medicine, University of Geneva, University Hospital of Geneva, Geneva, Switzerland.
• Dis. Colon Rectum. 2014 Feb 1; 57 (2): 201-9.

BackgroundVisceral obesity appears to be an emerging parameter affecting postoperative outcome after abdominal surgery. However, total visceral fat remains time consuming to calculate, and there is still a lack of data about its value as an independent risk factor in colorectal surgery.ObjectivesThe aim of this study was to validate the simple measurement of perirenal fat surface as a surrogate of visceral obesity, and to test the value of perirenal fat surface as a risk factor for morbidity in colorectal surgery and to compare it with the predictive value of other obesity parameters such as BMI and waist-hip ratio.DesignThis is a prospective observational cohort study.SettingThe study was conducted at a tertiary university hospital.PatientsTwo hundred twenty-four consecutive patients (130 male) undergoing elective colorectal surgery with a mean age of 65.2 years (SD, ±12.9) were identified.InterventionElective colorectal resections were performed.Main Outcome MeasuresWe assessed complications as the primary outcome measure. Secondary outcome measures were the conversion rates, duration of operation, and length of hospital stay.ResultsPerirenal fat surface was validated as a surrogate of visceral fat and a strong correlation between the 2 was confirmed (Spearman correlation coefficient ρ = 0.96). The overall postoperative complication rate was 22.8% (51/224) with 14.7% moderate complications (grade I and II) and 7.6% severe complications (grade III-IV), with a mortality rate of 0.5%. Multivariate analysis confirmed perirenal fat surface as an independent risk factor for postoperative complications (OR, 3.87; 95% CI, 1.73-8.64; p = 0.001), whereas BMI and waist-hip ratio were not statistically associated with postoperative complications (OR, 1.16; 95% CI, 0.51-2.66; p = 0.72).LimitationsThis study was limited by its sample size.ConclusionPerirenal fat surface is an excellent and easy-to-reproduce indicator of visceral fat volume. Furthermore, perirenal fat surface is an independent risk factor for postoperative outcome in colorectal surgery that appears to be of higher predictive value than BMI and waist-hip ratio.

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