Laparoscopic Versus an Open Colectomy in an Emergency Setting: A Case-Controlled Study

Abstract

PurposeLaparoscopy continues to be increasingly adopted for elective colorectal resections. However, its role in an emergency setting remains controversial. The aim of this study was to compare the outcomes between laparoscopic and open colectomies performed for emergency colorectal conditions.MethodsA retrospective review of all patients who underwent emergency laparoscopic colectomies for various surgical conditions was performed. These patients were matched for age, gender, surgical diagnosis and type of surgery with patients who underwent emergency open colectomies.ResultsTwenty-three emergency laparoscopic colectomies were performed from April 2006 to October 2011 for patients with lower gastrointestinal tract bleeding (6), colonic obstruction (4) and colonic perforation (13). The hand-assisted laparoscopic technique was utilized in 15 cases (65.2%). There were 4 (17.4%) conversions to the open technique. The operative time was longer in the laparoscopic group (175 minutes vs. 145 minutes, P = 0.04), and the duration of hospitalization was shorter in the laparoscopic group (6 days vs. 7 days, P = 0.15). The overall postoperative morbidity rates were similar between the two groups (P = 0.93), with only 3 patients in each group requiring postoperative surgical intensive-care-unit stays or reoperations. There were no mortalities. The cost analysis did not demonstrate any significant differences in the procedural (P = 0.57) and the nonprocedural costs (P = 0.48) between the two groups.ConclusionEmergency laparoscopic colectomy in a carefully-selected patient group is safe. Although the operative times were longer, the postoperative outcomes were comparable to those of the open technique. The laparoscopic group did not incur a higher cost.

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

“…The role of laparoscopy in colonic emergencies is less well-documented in the literature, and limited data is available regarding the same [38]. Various common colonic emergencies include perforation (iatrogenic or diverticular), obstruction, volvulus and colitis.…”

“…lower gastrointestinal bleed, toxic colitis and colonic ischaemia [38,53]. Though majority are performed with a laparotomy, the laparoscopic approach has been described by a few authors [51,53].…”

“…Though majority are performed with a laparotomy, the laparoscopic approach has been described by a few authors [51,53]. Total laparoscopic surgery is performed by fewer [53] as others used predominantly laparoscopic-assisted or hand-assisted techniques [38]. Majority of the limited available evidence favours laparoscopic surgery due to faster recovery and low complication rates [38,53,54].…”

“…Total laparoscopic surgery is performed by fewer [53] as others used predominantly laparoscopic-assisted or hand-assisted techniques [38]. Majority of the limited available evidence favours laparoscopic surgery due to faster recovery and low complication rates [38,53,54]. One Danish study did not find laparoscopic subtotal colectomy a feasible option due to high complication rate and high conversion (48 %) [55].…”

“…One Danish study did not find laparoscopic subtotal colectomy a feasible option due to high complication rate and high conversion (48 %) [55]. This may have been due to the limited laparoscopic experience of the surgeons as others have reported the conversion rates varying from 5 to 17.4 % [38,56]. Major reasons for conversions were found to be adhesions, difficult dissection [38], extremely distended bowel and doubtful bowel viability [54].…”