Re-Operative Laparoscopic Colorectal Surgery: A Systematic Review

Abstract

Introduction: Re-operative laparoscopic colorectal surgery is becoming increasingly common. It can be a challenging procedure, but its benefits can outweigh the associated risks. Methods: A systematic review of the literature reporting re-operative laparoscopic surgery was carried out. Retrospective and prospective cohort studies and case series were included, with case reports being excluded. Results: Seventeen articles dated from 2007 to 2020 were included in the systematic review. In total, 1555 patients were identified. Five hundred and seventy-four of them had a laparoscopic procedure and 981 an open re-operation. One hundred and eighty-three women had a laparoscopic operation. The median age ranged from to 44.9 years to 68.7 years. In seven studies, the indication of the index operation was malignancy, one study regarded re-laparoscopy for excision of lateral pelvic lymph nodes, and one study looked at redo surgery of ileal J pouch anal anastomosis. There were 16 mortalities in the laparoscopic arm (2.78%) and 93 (9.4%) in the open surgery arm. One hundred and thirty-seven morbidities were recorded in the open arm and 102 in the laparoscopic arm. Thirty-nine conversions to open occurred. The median length of stay ranged from 5.8 days to 19 days in laparoscopy and 9.7 to 34 days in the open surgery arm. Conclusions: Re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. The management of complications, recurrence of malignancy, and lateral pelvic floor dissection can be safely performed. The complication rate is low, with conversion to open procedures being relatively uncommon.

Outcomes of redo for failed colorectal or coloanal anastomoses: a systematic review and meta-analysis

“…Two other systematic reviews [ 25 , 26 ] evaluated redo anastomosis. Halkias et al [ 25 ] performed a systematic review without meta-analysis and evaluated only reoperative laparoscopic surgery.…”

“…Two other systematic reviews [ 25 , 26 ] evaluated redo anastomosis. Halkias et al [ 25 ] performed a systematic review without meta-analysis and evaluated only reoperative laparoscopic surgery. Fransvea et al [ 26 ] investigated the outcomes of laparoscopic redo management of early postoperative complications following laparoscopic colorectal surgery.…”

“…The authors focused on the LOS, morbidity, and mortality. Neither Halkias et al [ 25 ] nor Fransvea et al [ 26 ] investigated the incontinence rate or the probability of being free of stoma after redo surgery. Our study investigated redo surgery after colorectal resection, both by the traditional immediate redo procedure and the pull-through technique.…”

Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer

“…This is probably due to the potential of laparoscopy to reduce the systemic stress response in patients requiring repeated surgery [23]. As assessed in the recent review from Halkias et al [24] a key role is played by surgeons' expertise; pooling data from 17 articles dated from 2007 to 2020, the authors concluded that re-operative laparoscopic colorectal surgery is safe when performed by experienced hands. Similarly, Al-Rashedy and colleagues [25], focusing on the role of re-laparoscopy in the management of early bariatric surgery complications, described the importance of the surgeon's experience in choosing laparoscopy as reoperative approach.…”

Risk factors and mortality associated with multi-drug-resistant Gram-negative bacterial infection in adult patients following abdominal surgery

“…Several studies have demonstrated that re-exploration of the abdomen after the first operation was associated with prolonged length of ICU stay, higher mortality rate and more frequent wound infections [31][32][33]. The most common causes of re-laparotomy were bleeding, sepsis, anastomotic leaks, bowel obstruction and wound dehiscence.…”