0003 Endo + Colon
CONVERTED LAPAROSCOPIC COLON RESECTION; WHAT IS THE
TRUE MORBIDITY?
Belizon, A; Sardinha, T.C.; Sher, M.E.
North Shore-Long Island Jewish Medical Center, New Hyde Park, NY, USA
Purpose: To assess the clinical outcome and true morbidity of converted laparoscopic
colectomies as compared to open colectomies matched for diagnosis and severity of
disease.
Methods: All consecutive laparoscopic colon resections performed by a single surgeon
from 07/1996 to 10/2003 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 laparoscopicconverted colectomies were then matched with opened 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. Of those, 78
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 (4), crohn’s disease (3), cancer (3), others (2). Conversion
was higher in the left-sided (24 patients; 30.8%) vs. right-sided (4 patients; 6.1%)
procedures. There were no differences regarding age, gender, and co-morbidities
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 group, respectively. Morbidity and mortality are summarized in Table
1. Post-operative morbidity was significantly higher for laparoscopic procedures that
converted to open procedures more than 30 minutes into the operation. Pre-operative
predictors of conversion were extent of inflammatory process beyond the sigmoid
colon and obesity, while intra-operative predictors were adhesions and bleeding.
Conclusions:
Converted laparoscopic colon resection is associated with significantly greater
morbidity, particularly wound complications and greater length of stay, when
compared to open or laparoscopic colectomies. Prompt conversion (less than 30
minutes) may reduce the overall morbidity associated with converted procedures.
Furthermore, thoughtful patient selection may decrease the conversion rate and thereby
prevent the inherent, exaggerated morbidity associated with converted procedures.
Table 1
Morbidity
*ANOVA, P<0.0001
Wound Infection*
Incisional Hernia*
Anastomotic Leak*
Postoperative bleeding
Small bowel obstruction
Enterotomy
Fasciitis
Mortality
Converted
n=28(%)
9(32.1)*
8(28.5)*
2(7.1)*
0(0)
0(0)
1(3.5)
1(3.5)
1(3.5)
Open
n=28(%)
3(10.7)
2(7.1)
0(0)
1(3.5)
0(0)
0(0)
0(0)
0(0)
Laparoscopic
n=115(%)
2(1.7)
7(6.0)
1(0.8)
2(1.7)
2(1.7)
0(0)
1(0.8)
3(2.6)