Prior abdominal open surgery does not impair outcomes of laparoscopic colorectal surgery: a case–control study in 367 patients
Version of Record online: 25 JAN 2013
© 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
Volume 15, Issue 2, pages 236–243, February 2013
How to Cite
Maggiori, L., Cook, M. C., Bretagnol, F., Ferron, M., Alves, A. and Panis, Y. (2013), Prior abdominal open surgery does not impair outcomes of laparoscopic colorectal surgery: a case–control study in 367 patients. Colorectal Disease, 15: 236–243. doi: 10.1111/j.1463-1318.2012.03150.x
- Issue online: 25 JAN 2013
- Version of Record online: 25 JAN 2013
- Accepted manuscript online: 27 JUN 2012 10:30AM EST
- Received 27 September 2011; accepted 5 April 2012; Accepted Article online 27 June 2012
- Colorectal surgery;
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.