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NEED FOR STOMA DETERMINES LENGTH OF STAY AFTER LAPAROSCOPIC RECTAL SURGERY AND NOT CONVERSION TO OPEN SURGERY
Author(s) -
Jones O. M.,
Moran B. J.,
Cecil T. D.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04116_20.x
Subject(s) - medicine , stoma (medicine) , surgery , dissection (medical) , laparoscopic surgery , laparoscopy , colostomy , retrospective cohort study , general surgery
Purpose Published evidence suggests a shorter length of stay (LOS) following laparoscopic colorectal resection. Increased LOS may result from conversion to open surgery and post‐operative complications but these factors are generally unpredictable. By contrast, the need for a permanent or temporary stoma is often predictable and may alter the LOS. Methodology This was a retrospective analysis of a prospectively collected database of all laparoscopic rectal procedures performed under the care of one surgeon since June 2003. Conversion was defined as an incision made in order to progress the intra‐abdominal dissection, either by a midline, Pfannenstiel or targeted incision. Results 105 patients were included in the study (90 anterior resections, 10 abdomino‐perineal resections (APER), 3 Hartmann’s resections and 2 completion proctectomies). Conversion was performed in 27 patients (26%). Median LOS was 6 (range 3–83) days for the laparoscopic group and 7 (range 4–24) days for the converted group (p = ns). A stoma was performed in 27 patients (26%). Following anterior resection without stoma, median LOS was 6 (3–83) days. By contrast, after anterior resection with covering stoma, median LOS was 9 (3–30) days, whilst in those patients undergoing APER, Hartmann’s or completion proctectomy, the corresponding figure was 13 (5–35) days (p < 0.0001). Conclusions Conversion to open operation during laparoscopic rectal surgery did not increase mean LOS in this study. However, patients receiving a stoma have significantly longer hospital stays. Intensive pre‐ and post‐operative stoma education should be considered in these patients if overall in‐patient stay after laparoscopic surgery is to be reduced further.