Laparoscopic Colorectal Surgery in Patients with Prior Abdominal Surgery

Abstract

Purpose: We retrospectively investigated the impact of prior abdominal surgery on the outcome of laparoscopic colorectal surgery. Patients: Among 607 colorectal cancer patients who underwent laparoscopic surgery, 192 patients had previously undergone abdominal surgery (S group) and 415 had not (non-S group). Results: The percentage of female patients was higher in the S group than in the non-S group. The incidence of conversion to open surgery was higher in the S group (5.2%, 10/192) than in the non-S group (2.6%, 11/415), but the difference was not significant (p = 0.108). Although the mean operating time and estimated blood loss were similar in the two groups, right and transverse colectomy after prior gastrectomy and ipsilateral colectomy after prior colectomy took longer and were associated with greater blood loss. The morbidity rates of the two groups were similar (S group: 15.6%, 30/192; non-S group: 14.5%, 60/415). There were 5 intraoperative small-bowel injuries or postoperative small-bowel perforations in the S group, especially in the patients with prior gastrointestinal-tract surgery. Conclusion: Our findings suggest that there is no reason to avoid laparoscopic procedures in most patients with prior abdominal surgery despite a higher conversion rate, but caution is warranted in patients who have undergone major gastrointestinal-tract surgery.

Prior abdominal open surgery does not impair outcomes of laparoscopic colorectal surgery: a case–control study in 367 patients

“…Despite the longer operating time and higher conversion rate, the mortality and morbidity and length of hospital stay were not significantly different in patients with and without PAOS. This is consistent with other reports (Table 5) [12,13,22,24–27].…”

“…Two previous studies [12,26] have reported, as in the present study, a statistically higher conversion rate in patients with PAOS (Table 5). Furthermore, the conversion rate was higher in patients with PAOS in all other reports [13,22,24,25,27], although this did not reach statistical significance. These findings might be explained by the inclusion in the PAOS group of previous laparoscopic procedures and previous appendectomy by limited right lower‐quadrant incision, as Franko et al.…”

“…To date, eight studies [12,13,[22][23][24][25][26][27] have focused on the impact of PAOS on the outcome of laparoscopic colorectal procedures. Their authors concluded that PAOS should not be considered a contraindication for laparoscopic surgery.…”

“…Their authors concluded that PAOS should not be considered a contraindication for laparoscopic surgery. However, seven of these studies included previous laparoscopy or appendectomy by limited right lower-quadrant incision as PAOS [12,[22][23][24][25][26][27], two only focused on right colectomy [24,27] and most were impaired by serious methodological flaws, as only one study was case-controlled [13].…”

Learning Curve and Case Selection in Laparoscopic Colorectal Surgery

“…A recent study suggested that only major previous GI surgery increases complication rates. 55 Fourth, because the data are derived purely from self-taught surgeons, the recommendations may not be applicable to all. Currently, many surgeons have already gained experience in LCS during their residency.…”