Short-term outcomes of laparoscopic colorectal resection in patients with previous abdominal operations.

Background: Laparoscopic colorectal procedures (LCPs) are technically demanding; previous abdominal surgery may add to their complexity. The aim of our study was to assess the effect of previous abdominal surgery (PAS) on laparoscopic colorectal surgery.

Subjects And Methods: A prospective database was used to record LCPs between 2001 and 2011. Patients were divided into two groups: Group A consisted of patients with no PAS, and Group B of patients with PAS. Data collected included prior abdominal operations, type of LCP, operative time, and conversions. Operative mortality, morbidity, and ward stay in both groups were compared. Statistical analysis was performed using Fisher's exact test and Student's t test.

Results: One hundred eighty-one patients underwent LCPs: 113 in Group A and 68 in Group B. Mean operative time in Group A and Group B was 216.5 (range, 60-520) minutes and 233.2 (range, 114-544) minutes, respectively (P = .17). In the first 90 cases, the mean operative time was significantly lower for Group A (203 minutes) than in Group B (236.5 minute) (P = .02). The rate of conversion was 10.6% (12/113) in Group A and 13.2% (9/68) in Group B (P = .6). Two patients in Group B had small bowel enterotomies (1 missed on the operating table) compared with none in Group A. Morbidities were comparable in both groups. Median hospital stay was 4.5 and 4 days in Groups A and B, respectively (P=.9). There were 3 deaths in Group A (2 due to medical causes and 1 surgical-related). One surgical-related death (missed enterotomy) occurred in Group B.

Conclusions: Short-term outcomes of laparoscopic colorectal surgery in patients with PAS are acceptable. There is no significant difference in conversion rate, hospital stay, morbidity, or mortality. The difference in the operative time is significant only in the early part of the learning curve. Meticulous adhesiolysis to avoid and recognize enterotomy is of paramount importance.