Impact of pediatric obesity on abdominal surgery outcome: a narrative review

Background Childhood obesity has become a major global health concern and represents an increasingly relevant modifier of perioperative risk. In pediatric abdominal surgery, obesity is associated with anatomical, physiological, and immunometabolic alterations that may influence intraoperative management and postoperative outcomes. This narrative review aims to synthesize current evidence on the impact of obesity on surgical outcome in children undergoing abdominal procedures. Methods A narrative literature review was conducted using PubMed, Scopus, and Embase, focusing on studies published in the last 15 years. Evidence was qualitatively synthesized and organized thematically, prioritizing large cohort studies and national registries. No formal risk-of-bias assessment or meta-analysis was performed. Results Available evidence indicates that children with obesity undergoing abdominal surgery experience higher rates of perioperative respiratory adverse events, wound complications, prolonged operative times, and longer hospital stays, particularly in the presence of comorbidities such as obstructive sleep apnea syndrome (OSAS) and cardiometabolic dysfunction. The impact of obesity varies by procedure, with heterogeneous outcomes reported across appendectomy, colorectal surgery, and other abdominal interventions. Multidisciplinary perioperative strategies, including optimized airway management, multimodal opioid-sparing analgesia, respiratory physiotherapy, and thromboembolic prophylaxis, are associated with improved outcomes. Conclusions Obesity should be regarded as a risk amplifier rather than a contraindication to pediatric abdominal surgery. Tailored perioperative management and the adoption of obesity-adapted Enhanced Recovery After Surgery pathways may reduce complications, optimize resource utilization, and improve outcomes in this growing pediatric population.