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Laparoscopic Versus Open Re-operations Within 30 Days After Lower Gastrointestinal Tract Surgery: a Retrospective Comparative Study

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Abstract

Background

Re-operations within 30 days after lower gastrointestinal tract surgery are associated to high morbidity and mortality. Laparoscopic approach has been reported as feasible and safe in selected patients, but comparative data to laparotomy are scarce. The aim of this study was to review our experience in laparoscopic re-operations and compare it to laparotomy.

Methods

From January 2012 to December 2016, patients undergoing a re-operation within one month after lower gastrointestinal tract surgery were included and divided into laparoscopy and laparotomy groups. The primary endpoint was successful re-operation, defined as recovery without any of the following: conversion to laparotomy, need of further invasive treatments or death. Secondary outcomes were the length of hospital stay and 30-day morbidity and mortality. Demographic, clinical and surgical characteristics were collected and analyzed.

Results

Out of 114 patients who underwent a re-operation, 71 met the inclusion criteria. Thirty (42%) patients underwent laparoscopy and 41 (58%) laparotomy. Thirty (42%) patients were male and median age was 72.0 years-old. The initial operation was elective in 24 (34%) patients, and 50% of the initial operations were colorectal resections in both groups. Multivariate analyses showed that type of approach did not affect the re-operation success rate. Laparotomy was an independent predictor of prolonged hospital stay (OR 3.582, 95%CI 1.191–10.776, p = 0.023) and mortality (OR 13.123, 95%CI 1.301–131.579, p = 0.029).

Conclusions

Re-operations within 30 days after lower gastrointestinal tract surgery may be safe in selected patients, as effective as laparotomy, and associated with shorter hospital stay and lower mortality rates.

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References

  1. Küper MA, Eisner F, Königsrainer A et al (2014) Laparoscopic surgery for benign and malign diseases of the digestive system: indications, limitations, and evidence. World J Gastroenterol 20(17):4883–4891

    Article  Google Scholar 

  2. Mandrioli M, Inaba K, Piccinini A et al (2016) Advances in laparoscopy for acute care surgery and trauma. World J Gastroenterol 22(2):668–680

    Article  CAS  Google Scholar 

  3. Curtis NJ, Taylor M, Fraser L et al (2018) Can the combination of laparoscopy and enhanced recovery improve long-term survival after elective colorectal cancer surgery? Int J Colorectal Dis 33(2):231–234

    Article  CAS  Google Scholar 

  4. Simillis C, Lal N, Thoukididou SN et al (2019) Open versus laparoscopic versus robotic versus transanal mesorectal excision for rectal cancer: a systematic review and network meta-analysis. Ann Surg 270(1):59–68

    Article  Google Scholar 

  5. Wright DB, Koh CE, Solomon MJ (2017) Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery. Br J Surg 104(4):337–346

    Article  CAS  Google Scholar 

  6. Birkmeyer JD, Hamby LS, Birkmeyer CM et al (2001) Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 136(4):405–411

    Article  CAS  Google Scholar 

  7. Ricciardi R, Roberts PL, Read TE et al (2012) How often do patients return to the operating room after colorectal resections? Colorectal Dis 14(4):515–521

    Article  CAS  Google Scholar 

  8. Vennix S, Bakker OJ, Prins HA et al (2014) Re-interventions following laparoscopic surgery for colorectal cancer: data from 818 individuals from the Dutch surgical colorectal audit. J Laparoendosc Adv Surg Tech A 24(11):751–755

    Article  Google Scholar 

  9. Chang KH, Bourke MG, Kavanagh DO et al (2016) A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery. Surgeon 14(5):287–293

    Article  CAS  Google Scholar 

  10. Vennix S, Abegg R, Bakker OJ et al (2013) Surgical re-interventions following colorectal surgery: open versus laparoscopic management of anastomotic leakage. J Laparoendosc Adv Surg Tech A 23(9):739–744

    Article  Google Scholar 

  11. Lee CM, Huh JW, Yun SH et al (2015) Laparoscopic versus open reintervention for anastomotic leakage following minimally invasive colorectal surgery. Surg Endosc 29(4):931–936

    Article  Google Scholar 

  12. Ha HK, Kim JS, Lee MS et al (1997) Differentiation of simple and strangulated small-bowel obstructions: usefulness of known CT criteria. Radiology 204(2):507–512

    Article  CAS  Google Scholar 

  13. Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17(5):962–972

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  15. Dexter SP, Miller GV, Davides D et al (2000) Relaparoscopy for the detection and treatment of complications of laparoscopic cholecystectomy. Am J Surg 179(4):316–319

    Article  CAS  Google Scholar 

  16. Rosin D, Zmora O, Khaikin M et al (2004) Laparoscopic management of surgical complications after a recent laparotomy. Surg Endosc 18(6):994–996

    Article  CAS  Google Scholar 

  17. Boyce SA, Harris C, Stevenson A et al (2017) Management of low colorectal anastomotic leakage in the laparoscopic era: more than a decade of experience. Dis Colon Rectum 60(8):807–814

    Article  Google Scholar 

  18. Cuccurullo D, Pirozzi F, Sciuto A et al (2015) Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 29(7):1795–1803

    Article  Google Scholar 

  19. Eriksen JR, Ovesen H, Gögenur I (2018) Short- and long-term outcomes after colorectal anastomotic leakage is affected by surgical approach at reoperation. Int J Colorectal Dis 33(8):1097–1105

    Article  Google Scholar 

  20. Wind J, Koopman AG, van Berge Henegouwen MI et al (2007) Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery. Br J Surg 94(12):1562–1566

    Article  CAS  Google Scholar 

  21. Rotholtz NA, Laporte M, Lencinas SM et al (2009) Is a laparoscopic approach useful for treating complications after primary laparoscopic colorectal surgery? Dis Colon Rectum 52(2):275–279

    Article  Google Scholar 

  22. Joh YG, Kim SH, Hahn KY et al (2009) Anastomotic leakage after laparoscopic protectomy can be managed by a minimally invasive approach. Dis Colon Rectum 52(1):91–96

    Article  Google Scholar 

  23. Kwak JM, Kim SH, Son DN et al (2011) The role of laparoscopic approach for anastomotic leakage after minimally invasive surgery for colorectal cancer. J Laparoendosc Adv Surg Tech A 21(1):29–33

    Article  Google Scholar 

  24. Pinto RA, Campos FG, Araujo SA et al (2012) Feasibility of laparoscopic reoperation for early complications after laparoscopic colorectal resections. Surg Endosc 23(Suppl 1):S276

    Google Scholar 

  25. Haas EM, Pedraza R, Faraj C et al (2013) Reoperative minimally invasive surgery for the management of colorectal surgical complications. Surg Endosc 27(Suppl 1):S335

    Google Scholar 

  26. Borghi F, Giraudo G, Pellegrino L et al (2015) Postoperative peritonitis after laparoscopic colorectal surgery: minimally invasive management. Surg Endosc 29(Suppl 1):S10

    Google Scholar 

  27. Kirshtein B, Roy-Shapira A, Domchik S et al (2008) Early relaparoscopy for management of suspected postoperative complications. J Gastrointest Surg 12(7):1257–1262

    Article  Google Scholar 

  28. Marano A, Giuffrida MC, Giraudo G et al (2017) Management of peritonitis after minimally invasive colorectal surgery: can we stick to laparoscopy? J Laparoendosc Adv Surg Tech A 27(4):342–347

    Article  Google Scholar 

  29. O’Riordan JM, Larkin JO, Mehigan BJ et al (2013) Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery. Surgeon 11(4):183–186

    Article  CAS  Google Scholar 

  30. Di Saverio S (2014) Emergency laparoscopy: a new emerging discipline for treating abdominal emergencies attempting to minimize costs and invasiveness and maximize outcomes and patients’ comfort. J Trauma Acute Care Surg 77(2):338–350

    Article  Google Scholar 

  31. Boney O, Moonesinghe SR, Myles PS, Grocott MP (2016) Standardizing endpoints in perioperative research. Can J Anaesth 63(2):159–168. https://doi.org/10.1007/s12630-015-0565-y

    Article  PubMed  Google Scholar 

  32. Di Saverio S, Vennix S, Birindelli A et al (2016) Pushing the envelope: laparoscopy and primary anastomosis are technically feasible in stable patients with Hinchey IV perforated acute diverticulitis and gross faeculent peritonitis. Surg Endosc 30(12):5656–5664

    Article  Google Scholar 

  33. Kulkarni SV, Naik AS, Subramanian N Jr (2007) APACHE-II scoring system in perforative peritonitis. Am J Surg 194(4):549–552

    Article  Google Scholar 

  34. Bosscha K, Reijnders K, Hulstaert PF et al (1997) Prognostic scoring systems to predict outcome in peritonitis and intra-abdominal sepsis. Br J Surg 84(11):1532–1534

    CAS  PubMed  Google Scholar 

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Acknowledgements

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Authors and Affiliations

  1. Department of Surgery, Ospedale Regionale Di Lugano, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland

    Sona Deretti, Francesco Mongelli, Giulia Staccini, Nicole Murgante, Pietro Majno-Hurst & Dimitri Christoforidis

  2. Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland

    Dimitri Christoforidis

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  1. Sona Deretti
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  2. Francesco Mongelli
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  3. Giulia Staccini
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  4. Nicole Murgante
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Correspondence to Francesco Mongelli.

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Conflict of interest

All authors have no conflicts of interest or financial ties to disclose. All authors have contributed significantly to the content of the article and it was read and approved by all authors.

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This original report has not been previously published or submitted elsewhere for publication.

Ethical standards

Written non-opposition consents were administered to patients and the local the local ethics committee approved the study (Comitato Etico Cantonale Ticino num. 2017–02,153 CE 3304) in compliance with the actual Swiss ethical requirements.

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Sona Deretti and Francesco Mongelli contributed equally to the paper.

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Deretti, S., Mongelli, F., Staccini, G. et al. Laparoscopic Versus Open Re-operations Within 30 Days After Lower Gastrointestinal Tract Surgery: a Retrospective Comparative Study. World J Surg 45, 1548–1560 (2021). https://doi.org/10.1007/s00268-021-05970-3

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  • DOI: https://doi.org/10.1007/s00268-021-05970-3

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