Laparoscopic surgery: pitfalls due to anesthesia, positioning, and pneumoperitoneum

Effectiveness of colorectal laparoscopic surgery on patients at high anesthetic risk: an intervention cohort study

AIMS

The aim of the study was to assess the effectiveness of laparoscopic colorectal surgery in patients at high preoperative anesthetic risk because of associated pathologies.

MATERIALS AND METHODS

From January 2003 until January 2005, 116 patients were systematically assigned at a ratio of 1:1 to one of two groups: laparoscopy surgery (n=59, of which 31 were American Society of Anesthesiologists score [ASA] I-II [L1] and 28 ASA III-IV [L2]) or open surgery (n=57, of which 30 were ASA I-II [O1] and 27 ASA III-IV [O2]). Data on patient demographics and clinical and anesthetic variables were collected prospectively. Informed consent was obtained from the patients, and approval was obtained from the designated review board of the institution involved.

RESULTS

The number of minor anesthetic complications during surgery was higher in L2 patients. No differences were observed in blood gas parameters studied during surgery (pCO(2), pH, and pO(2)/FiO(2)). Transfusion rates in the laparoscopy group at greater anesthetic risk (L2) were lower than those of the high-risk conventional surgery group (O2; 21.4 vs 63%, P<0.02). Duration of stay in the surgical recovery room and the inpatient ward were also shorter in the L2 group than in the O2 group (8.7+/-4.5 vs 12.2+/-6 days, P=0.02). There was no difference in perioperative clinical variables between laparoscopy groups (L1, L2).

CONCLUSION

Postoperative recovery of ASA III-IV patients is better after laparoscopic surgery for colorectal cancer, at the expense of a higher rate of minor anesthetic occurrences during surgery.