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Complications after laparoscopic and open subtotal colectomy for inflammatory colitis: a case‐matched comparison
Author(s) -
Parnaby C. N.,
Ramsay G.,
Macleod C. S.,
Hope N. R.,
Jansen J. O.,
McAdam T. K.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12330
Subject(s) - medicine , surgery , colectomy , blood loss , laparoscopic surgery , retrospective cohort study , refractory (planetary science) , laparoscopy , ulcerative colitis , physics , disease , astrobiology
Aim The aim of this study was to compare the early postoperative outcome of patients undergoing laparoscopic subtotal colectomy with those undergoing open subtotal colectomy for colitis refractory to medical treatment. Method A retrospective observational study was carried out of patients who underwent subtotal colectomy for refractory colitis, at a single centre, between 2006 and 2012. Patients were matched for age, gender, American Society of Anesthesiology ( ASA ) grade, urgency of operation and immunosuppressant/modulator treatment. The primary outcome measure was the number of postoperative complications, classified using the Clavien–Dindo scale. Secondary end‐points included procedure duration, laparoscopic conversion rates, blood loss, 30‐day readmission rates and length of hospital stay. Results Ninety‐six patients were included, 39 of whom had laparoscopic surgery. Thirty‐two of these were matched to similar patients who underwent an open procedure. The overall duration of the procedure was longer for laparoscopic surgery than for open surgery (median: 240 vs 150 min, P < 0.005) but estimated blood loss was less (median: 75 vs 400 ml, P < 0.005). In the laparoscopic group, 23 patients experienced 27 complications, and in the open surgery group, 23 patients experienced 30 complications. Most complications were minor (Grade I/II), and the distribution of complications, by grade, was similar between the two groups. There was no statistically significant difference in 30‐day readmission rates between the laparoscopic and open groups (five readmissions vs eight readmissions, P = 0.536). Length of hospital stay was 4 days shorter for laparoscopic surgery, but this difference was not statistically significant (median: 7 vs 11 days, P = 0.159). Conclusion In patients requiring colectomy for acute severe colitis, laparoscopic surgery reduced blood loss but increased operating time and was not associated with a reduction in early postoperative complications, length of hospital stay or readmission rates.