The Role of Laparoscopic Approach for Anastomotic Leakage After Minimally Invasive Surgery for Colorectal Cancer

Abstract

Compared with conventional open treatment of anastomotic leakage, the laparoscopic approach resulted in fewer wound complications and tendency of early recovery of bowel movement without an increase in adverse outcomes. Using a laparoscopic approach, all the advantages of minimally invasive surgery can be realized in patients who develop anastomotic leakage after minimally invasive surgery.

Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery

“…Two studies reported statistically significant differences in ASA grades among the patients. In the study reported by Kwak and colleagues, there was a significant difference in the proportion of patients with a high ASA grade; six patients in the OR group ( versus 0 of 26 in the laparoscopic group) had a high ASA grade owing to their acute presentation ( P = 0·027). Vennix and colleagues included a higher proportion of patients with an ASA grade of III–IV who had OR than LR (24·3 versus 17·0 per cent; P = 0·048).…”

“…The rate of second reoperation in the comparative studies ranged from 0 to 12 and 0 to 28 per cent in the LR and OR groups respectively. The study with the highest secondary reoperation rate (12 per cent) following LR also had a high proportion of patients who required repeat reoperations in the open group (19 per cent).…”

“…Left‐sided colectomies were the next most common procedure overall in comparative studies, representing 13·3 per cent of primary operations in patients who had LR and 9·8 per cent in those who had OR. Three studies did not indicate the types of resection performed at the primary operation.…”

“…Lee and colleagues reported individual complications, and recorded a statistically lower rate of wound dehiscence and intra‐abdominal infection following LR, but not ileus or wound infection. Kwak et al ,. on the other hand, reported fewer wound infections in the LR group ( P = 0·031), but no significant difference in the incidence of intraperitoneal abscess, ileus, or pulmonary or septic complications between the two groups of reoperated patients.…”

“…In the study by Joh and colleagues 28 , all patients underwent laparoscopic exploration before deciding the operative approach. Five studies 26,28,29,33,34 reported indications for specific operative procedures after intraoperative identification of the postoperative complication. The definition of early reoperation varied across reports, with one study 34 using 6 weeks as the cut-off, and another 31 30 days.…”