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Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion

Abstract

Background

Conversion to an open procedure during laparoscopically assisted colorectal resection may be necessary because of technical, patient, or pathologic factors. Recent literature has indicated that converted patients may have poorer outcomes than those undergoing open or completed laparoscopically assisted procedure. This study aimed to audit the authors’ experience with laparoscopically assisted colectomy and to assess the clinical outcomes of patients undergoing conversion.

Methods

All laparoscopic right hemicolectomies or anterior resections performed at seven South Australian hospitals from 1997 to 2006 were reviewed. Data pertaining to patient sex, age, American Society of Anesthesiology (ASA) score, pathology, operative outcomes including operating time, conversion, reason for conversion, length of hospital stay, and intra- and postoperative complications were analyzed.

Results

Laparoscopic anterior resection had a higher rate of open conversion than laparoscopic right hemicolectomy (18.7% vs 10.4%; p = 0.028). In the right hemicolectomy group, none of the investigated risk factors for conversion were statistically significant, and the morbidity rates for the two groups were similar. The median hospital stay was significantly longer in the anterior resection group (p < 0.001), and the wound morbidity rate was higher in the converted group (12.8% vs 3.0%; p = 0.022). Age older than 75 years and a high ASA status were independent risk factors for conversion in anterior resection.

Conclusions

Conversion of laparoscopic anterior resection to open procedure is associated with higher wound morbidity and a longer hospital stay. The authors recommend that surgeons carefully consider the selection of patients 75 years of age or older and high ASA status for laparoscopic anterior resection.

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Acknowledgments

The authors thank Mr. David Rodda, Mr. Andrew Luck, and Mr. Alex Karatassas for allowing access to their data.

Author information

Correspondence to J. H. Stephens.

Additional information

Presented in part as a virtual poster at the Royal Australasian College of Surgeons Annual Scientific Congress, Christchurch, New Zealand, May 2007, and as a podium presentation at the Annual Scientific Meeting of the Royal Australasian College of Surgeons South Australian Branch, Friday, 4 August 2006.

Appendix 1. Other complications for right hemicolectomy (RHC) and anterior resection (AR)

Appendix 1. Other complications for right hemicolectomy (RHC) and anterior resection (AR)

Table 8  

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Tan, P.Y., Stephens, J.H., Rieger, N.A. et al. Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion. Surg Endosc 22, 1708–1714 (2008). https://doi.org/10.1007/s00464-007-9702-1

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Keywords

  • Colectomy
  • Colon
  • Conversion
  • Minimally invasive surgical procedures