Converted laparoscopic colectomy |
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Authors: | A Belizon C T Sardinha M E Sher |
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Institution: | (1) Department of Surgery, Long Island Jewish Hospital, North Shore Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA |
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Abstract: | Background The safety and benefits of laparoscopic colon resection are well documented. However, few reports have addressed the safety
and comparative outcome of laparoscopic colon operations that necessitated conversion.
Methods All consecutive laparoscopic colon resections performed by a single surgeon from July 1996 to October 2003 were assessed.
Data obtained from a prospective computerized database included demographics, diagnosis, reason and time to conversion, length
of stay, morbidity, and mortality. Additionally, all laparoscopic-converted colectomies were then matched with open colectomies
by diagnosis and severity of disease and analyzed with respect to morbidity, mortality, and clinical outcome.
Results A total of 143 laparoscopic colon resections were analyzed, 78 of which were left colon resections and 65 were right colon
resections. The overall conversion rate was 19.6% (28 patients). The disease entities of the 28 converted patients were diverticulitis
(16), polyps (four), Crohn’s disease (three), metastatic cancer (three), and others (two). Conversion was higher in the left-sided
(24 patients, 30.8%) versus right-sided (four patients, 6.1%) procedures. There were no differences regarding age, gender,
and comorbidities among the laparoscopic, open, and converted groups; the median follow-up was 39 months. The median length
of stay was 6, 8, and 12 days for the laparoscopic, open, and converted groups, respectively. Right-sided conversions were
due to the size of the inflammatory mass in three patients and intraoperative bleeding in one patient. Left-sided conversions
were due to the inflammatory process extending beyond the sigmoid colon in 12 patients, adhesions in five, obesity in four,
pericolonic abscess in two, and fixed mass in one patient. Postoperative morbidity was significantly higher for laparoscopic
procedures that were converted to open procedures more than 30 min into the operation. Preoperative predictors of conversion
were extent of inflammatory process beyond the sigmoid colon and obesity, whereas intraoperative predictors were adhesions
and bleeding.
Conclusions Laparoscopic-converted colon resection is associated with significantly greater morbidity, particularly wound complications
and greater length of hospital stay, compared to open or laparoscopic colectomies. Prompt conversion (<30 min) may reduce
the overall morbidity associated with converted procedures. Furthermore, thoughtful patient selection may decrease the conversion
rate and thereby prevent the inherent morbidity associated with converted procedures. |
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Keywords: | Laparoscopic colectomy Conversion Morbidity Open colectomy |
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