Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results

Marusch, F.; Gastinger, I.; Schneider, Claus; Scheidbach, H.; Konradt, J.; Bruch, Hans–Peter; Köhler, L.; Bärlehner, E.; Köckerling, F.

doi:10.1007/s004640000340

Cited by 139 publications

(124 citation statements)

References 24 publications

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“…Although there were no major differences in perioperative care and patient recovery after elective colonic surgery between European and US patients [22], postoperative length of stay was only 7 days in the United States but 10–13 days in European countries. In Germany, the postoperative hospital stay after colonic cancer surgery is as long as 17 days [24], and even patients undergoing laparoscopic colonic resection remain in hospital for 11–12 days after surgery [25]. Factors other than patient recovery which are responsible for the traditionally prolonged stay in German hospitals include: the reimbursement system hardly ever penalizes postoperative hospital stay; general practitioners are reluctant to treat patients who are discharged early after surgery; many hospitals do not have adequate outpatient facilities to take care of these patients; surgeons fear major complications after discharge (e.g.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

Braumann

Guenther

Wendling³

et al. 2009

Dig Surg

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Aim: Multimodal perioperative rehabilitation in patients undergoing curative conventional colonic resection for cancer has not yet been studied in a multicenter setting. In 2005, a nationwide quality assurance program was initiated in Germany in an unselected patient population. Methods: The prospective multicenter data collection includes patients from 24 German hospitals. All hospitals had established ‘fast-track’ rehabilitation as the standard perioperative treatment in elective colonic resection, and all patients entered the registry. Results: 748 of 2,047 fast-track patients (36.5%) underwent open resection of colonic cancer. The median age of the 380 female and 368 male patients was 71 (26–96) years. Compliance was high for epidural analgesia (89%), systemic basic nonopioid analgesia (93%), ‘restrictive’ intraoperative intravenous fluids (81%), oral feeding (73%) and enforced mobilization (84%) on the day of surgery. Surgical complications were diagnosed in 20%, general morbidity occurred in only 13% of all patients, and 3 patients (0.4%) died in the early postoperative period. Readmission within 30 days of discharge was necessary in 27 patients (4%). Conclusions: Compliance with fast-track measures was high, and general morbidity was low in a population of patients undergoing multimodal perioperative rehabilitation for conventional colonic cancer resection.

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Section: Discussionmentioning

confidence: 99%

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

Braumann

Guenther

Wendling³

et al. 2009

Dig Surg

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“…It should be emphasised that appropriate early conversion can reduce intraoperative complications and postoperative morbidity. 5,52,71 Some have advocated the use of resection-facilitated and handassisted techniques to reduce conversion rates. In a comparative study of laparoscopic versus resectionfacilitated management of complicated diverticulitis, Eijsbouts et al demonstrated improved outcomes with the resection-facilitated approach.…”

Section: Laparoscopic Managementmentioning

confidence: 99%

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Marney

2013

International Surgery

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Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P ¼ 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.

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“…De esta forma, muchas veces un residente es el cirujano principal, pero es guiado por un miembro experimentado del equipo. Marusch et al 19 , en un estudio multicéntrico con más de 1.000 pacientes, cirujanos con más de 100 procedimientos se embarcan en procedimientos más complejos, lo que produce una curva bimodal en el gráfi co de conversión. Así mismo, tampoco, se encontró diferencias entre los primeros 200 casos y el resto de la serie.…”

Section: Discussionunclassified

Análisis de los factores predictivos de conversión en cirugía laparoscópica colorrectal

et al. 2011

Rev Chil Cir

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Analysis of predictive factors for conversion to open surgery in laparoscopic colorectal surgeryBackground: Conversion to open surgery of laparoscopic procedures is not in essence a complication, but invalidates the benefi ts of laparoscopy. Aim: To identify the predictive factors for conversion in laparoscopic colorectal surgery. Material and Methods: Revision of medical records of all patients with colorectal disease operated using a laparoscopic approach, from 1998 to 2010. Gender, age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), previous abdominal surgery, elective/urgency procedure, benign/malignant disease, type of resection and surgeon experience were recorded. A logistic regression model was done to determine which variables were predictive for conversion to open surgery. Results: The medical records of 582 patients aged 57 ± 17 years (45% men) were analyzed. The rate of conversion to open surgery was 7.1%. The logistic regression model selected as predictors of conversion a BMI over 25 kg/m

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Experience as a factor influencing the indications for laparoscopic colorectal surgery and the results

Cited by 139 publications

References 24 publications

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

Multimodal Perioperative Rehabilitation in Elective Conventional Resection of Colonic Cancer: Results from the German Multicenter Quality Assurance Program ‘Fast-Track Colon II’

Laparoscopic Management of Diverticular Colovesical Fistula: Experience in 15 Cases and Review of the Literature

Análisis de los factores predictivos de conversión en cirugía laparoscópica colorrectal

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