Premium
Prior abdominal open surgery does not impair outcomes of laparoscopic colorectal surgery: a case–control study in 367 patients
Author(s) -
Maggiori L.,
Cook M. C.,
Bretagnol F.,
Ferron M.,
Alves A.,
Panis Y.
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/j.1463-1318.2012.03150.x
Subject(s) - medicine , colorectal surgery , surgery , body mass index , abdominal surgery , anesthesiology , laparoscopic surgery , prospective cohort study , laparoscopy , anesthesia
Aim This prospective case‐matched study was conducted to compare the outcome of laparoscopic colorectal surgery in patients with and without prior abdominal open surgery (PAOS). Method From June 1997 to December 2010, 167 patients with PAOS (including midline, Pfannenstiel, subcostal, right upper quadrant or transverse incision) were manually matched to all identical patients without PAOS from our prospective laparoscopic colorectal surgery database. Matching criteria included age, gender, American Society of Anesthesiology (ASA) score, body mass index, diagnosis and surgical procedure performed. Primary end‐points were postoperative 30‐day mortality and morbidity. Secondary end‐points included operating time, conversion rate and length of stay. Results A total of 367 patients (167 with PAOS and 200 without PAOS) were included in this study. PAOS was associated with a significantly increased mean operating time (229 ± 66 min vs 216 ± 71 min, P = 0.044). The conversion rate was significantly higher in patients with PAOS, compared with patients without PAOS (22% vs 13%, P = 0.017). There was one (0.3%) postoperative death. The overall postoperative morbidity rate was similar in both groups (22% vs 19%, P = 0.658), including Grade 3 or Grade 4 morbidity, according to Dindo’s classification (5% vs 5%, P = 0.694). Mean hospital stay showed no difference between both groups (10 ± 7 days vs 9 ± 5 days, P = 0.849). Conclusion This large case–control study suggests that PAOS does not affect postoperative outcomes. For this reason, a systematic laparoscopic approach in patients with PAOS, even with midline incision, should be considered in colorectal surgery.