Effect of previous abdominal surgery on outcomes following laparoscopic colorectal surgery

Abstract

Objective: The impact of previous abdominal surgeries on the need for conversion to open surgery and on short-term outcomes during/after laparoscopic colectomy was retrospectively investigated.

Design: This retrospective cohort study was conducted from December 1996 through December 2009.

Setting: This study was conducted at Osaka Medical College Hospital.

Patients: A total of 1701 consecutive patients who had undergone laparoscopic resection of the colon and rectum were classified as not having previous abdominal surgery (n = 1121) or as having previous abdominal surgery (n = 580).

Main outcome measures: Short-term outcomes were recorded, and risk factors for conversion to open surgery were analyzed.

Results: There were no significant differences in operative time, blood loss, number of lymph nodes removed, or conversion rate between the groups. The rate of inadvertent enterotomy was significantly higher in the previous abdominal surgery group than in the not having previous abdominal surgery group (0.9% versus 0.1%; p = 0.03), and the postoperative recovery time was significantly longer in the previous abdominal surgery group than in the not having previous abdominal surgery group. Ileus was more frequent in the previous abdominal surgery group than in the not having previous abdominal surgery group (3.8% versus 2.1%; p = 0.04). Significant risk factors for conversion to open surgery were T stage ≥3 (OR, 2.81; 95% CI, 1.89-3.75), median incision (OR, 4.34; 95% CI, 1.23-9.41), upper median incision (OR, 2.78; 95% CI, 1.29-5.42), lower median incision (OR, 1.82; 95% CI, 1.09-3.12), and transverse colectomy (OR, 1.76; 95% CI, 1.29-2.41).

Conclusion: The incidence of successfully completed laparoscopic colectomy after previous abdominal surgery remains high, and the short-term outcomes are acceptable.