M. Sanghvi1, A. A. Maung1, K. A. Davis1, K. M. Schuster1 1Yale University School Of Medicine,Surgery,New Haven, CT, USA
Introduction: Fewer complications and shorter lengths of stay have been demonstrated for laparoscopic as compared to open approaches in elective colorectal operations. This experience has been expanded to include the use of laparoscopy for urgent or emergent colorectal conditions, despite a paucity of supporting evidence. We hypothesized that post-operative outcomes would be improved with a laparoscopic approach in emergency colorectal operations.
Methods: All NSQIP urgent or emergent targeted colectomy cases from 2012 to 2014 were reviewed. Outcomes included 30-day mortality and morbidity including: surgical site infection, anastomotic leak, other infectious complications, cardiovascular complications, renal failure, venous thromboembolism prolonged ileus, reoperation and length of hospital stay. Demographics, comorbidities, pre-operative lab results, wound class, ASA class and pre-operative functional status were assessed for risk adjustment. To assess the effect of attempting laparoscopy compared to an initial laparotomy, laparoscopy and laparoscopy converted to laparotomy were included in the laparoscopy group. Logistic and log-linear models were constructed to assess outcomes.
Results: There were 4877 patients in the laparotomy group and 809 in the laparoscopy group, 435 of which were laparoscopies converted to laparotomy. Unadjusted mortality was lower in the laparoscopic group (4.6% vs 14.2%; p<0.001), however after adjustment for confounders, a laparoscopic approach was no longer significantly associated with mortality (OR 0.698; 95% CI 0.45-1.09; p=0.115). After adjustment overall thirty day morbidity was lower although anastomotic leak was higher (table). Hospital stay was approximately 1 day shorter with laparoscopy. The type of surgical approach chosen did not impact the incidence of surgical site infection, prolonged post-operative ileus and reoperation rates.
Conclusion: Laparoscopic surgery in emergency colorectal operations appears to have comparable outcomes compared to laparotomy with shorter length of hospital stay. Laparoscopy may be associated with a higher leak rate, but lower overall morbidity when considering all cardiovascular, pulmonary and renal complications. Additional studies should investigate the impact of laparoscopy on anastomotic leak in emergency colorectal surgery.
