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Rama NJG, Lourenço Ó, Motta Lima PC, Guarino MPS, Parente D, Castro R, Bento A, Rocha A, Castro-Poças F, Pimentel J. Development of a warning score for early detection of colorectal anastomotic leakage: Hype or hope? World J Gastrointest Surg 2022; 14:1297-1309. [PMID: 36504511 PMCID: PMC9727571 DOI: 10.4240/wjgs.v14.i11.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/12/2022] [Accepted: 10/28/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Colorectal anastomotic leakage (CAL), a severe postoperative complication, is associated with high morbidity, hospital readmission, and overall healthcare costs. Early detection of CAL remains a challenge in clinical practice. However, some decision models have been developed to increase the diagnostic accuracy of this event.
AIM To develop a score based on easily accessible variables to detect CAL early.
METHODS Based on the least absolute shrinkage and selection operator method, a predictive classification system was developed [Early ColoRectAL Leakage (E-CRALL) score] from a prospective observational, single center cohort, carried out in a colorectal division from a non-academic hospital. The score performance and CAL threshold from postoperative day (POD) 3 to POD5 were estimated. Based on a precise analytical decision model, the standard clinical practice was compared with the E-CRALL adoption on POD3, POD4, or POD5. A cost-minimization analysis was conducted, on the assumption that all alternatives delivered similar health-related effects.
RESULTS In this study, 396 patients who underwent colorectal resection surgery with anastomosis, and 6.3% (n = 25) developed CAL. Most of the patients who developed CAL (n = 23; 92%) were diagnosed during the first hospital admission, with a median time of diagnosis of 9.0 ± 6.8 d. From POD3 to POD5, the area under the receiver operating characteristic curve of the E-CRALL score was 0.82, 0.84, and 0.95, respectively. On POD5, if a threshold of 8.29 was chosen, 87.4% of anastomotic failures were identified with E-CRALL adoption. Additionally, score usage could anticipate CAL diagnosis in an average of 5.2 d and 4.1 d, if used on POD3 and POD5, respectively. Regardless of score adoption, episode comprehensive costs were markedly greater (up to four times) in patients who developed CAL in comparison with patients who did not develop CAL. Nonetheless, the use of the E-CRALL warning score was associated with cost savings of €421442.20, with most (92.9%) of the savings from patients who did not develop CAL.
CONCLUSION The E-CRALL score is an accessible tool to predict CAL at an early timepoint. Additionally, E-CRALL can reduce overall healthcare costs, mainly in the reduction of hospital costs, independent of whether a patient developed CAL.
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Affiliation(s)
- Nuno J G Rama
- Division of Colorectal Surgical, Leiria Hospital Centre, Leiria 2410-021, Portugal
- Abel Salazar Biomedical Institute, University of Oporto, Oporto 4099-002, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria 2410-541, Portugal
| | - Óscar Lourenço
- Faculty of Economics, CeBER, University of Coimbra, Coimbra 3000-137, Portugal
| | | | - Maria Pedro S Guarino
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria 2410-541, Portugal
| | - Diana Parente
- Division of Colorectal Surgical, Leiria Hospital Centre, Leiria 2410-021, Portugal
| | - Ricardo Castro
- Division of Clinical Pathology, Leiria Hospital Centre, Leiria 2410-541, Portugal
| | - Ana Bento
- Division of Clinical Pathology, Leiria Hospital Centre, Leiria 2410-541, Portugal
| | - Anabela Rocha
- Abel Salazar Biomedical Institute, University of Oporto, Oporto 4099-002, Portugal
- Division of Surgical, Oporto Hospital Centre, Oporto 4099-001, Portugal
| | - Fernando Castro-Poças
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Oporto 4099-001, Portugal
- Institute of Biomedical Sciences Abel Salazar, University of OPorto, Oporto 4099-001, Portugal
| | - João Pimentel
- Faculty of Medicine, University of Coimbra, Coimbra 3004-531, Portugal
- Division of Surgical, Montes Claros Hospital, Coimbra 3030-320, Portugal
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Portale G, Pedon S, Rettore C, Cipollari C, Zuin M, Spolverato Y, Cancian L, Fiscon V. Internal hernia following laparoscopic anterior resection for cancer: higher prevalence than expected of an under-reported complication. Int J Colorectal Dis 2022; 37:331-335. [PMID: 34766204 DOI: 10.1007/s00384-021-04044-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Internal hernia (IH) after laparoscopic colorectal surgery is a potentially severe complication. It may go undiagnosed in patients having their abdominal CT scan during oncologic follow-up. We evaluated the occurrence of IH on CT scans after laparoscopic curative resection for rectal cancer (LRRC) and routine closure of the mesenteric defect. METHODS Data from 189 consecutive patients undergoing elective curative LRRC in a 14-year period (June 2005-june 2019) were prospectively collected. Only patients with abdominal CT scans, performed as routine oncologic follow-up, between 3 months and 7 years post-operatively were included in the study and reviewed by a surgeon and a radiologist. RESULTS A total of 161 patients were eligible for the study with a median age of 69 years (IQR: 59-77) at surgery. They had abdominal follow-up CT scans at a median of 39.5 months (IQR: 12.8-62.7) after surgery. The prevalence of IH was 11.2% (18/161 patients). Of the 18 patients, 15 (83.3%) were fully asymptomatic, 2 (11.1%) reported chronic abdominal discomfort (including mostly nausea and colicky pain) during their oncologic follow-up (however, IH was not suspected neither prompted additional investigations), and 1 (5.6%) was reoperated elsewhere for IH and acute small bowel obstruction. CONCLUSIONS IH following LRRC is not uncommon, with a prevalence > 10% in our experience. Most of these patients remain fully asymptomatic, but in a few patients, IH might be responsible for some symptoms or require reoperation. Awareness of this complication is important, given the potential risk of acute small bowel obstruction.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy.
| | - Sabrina Pedon
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Carlo Rettore
- Department of Radiology, ULSS 6 Euganea, Cittadella, Italy
| | - Chiara Cipollari
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Matteo Zuin
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Ylenia Spolverato
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
| | - Luca Cancian
- Department of Radiology, ULSS 6 Euganea, Cittadella, Italy
| | - Valentino Fiscon
- Department of General Surgery, ULSS 6 Euganea, Via Casa di Ricovero 40, 35013, Cittadella, Padova, Italy
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Rotholtz NA, Angeramo CA, Laporte M, Matzner Perfumo M, Schlottmann F, Bun ME. "Early" Reoperation to Treat Complications Following Laparoscopic Colorectal Surgery: The Sooner the Better. Surg Laparosc Endosc Percutan Tech 2021; 31:756-759. [PMID: 34406166 DOI: 10.1097/sle.0000000000000984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Some postoperative complications after laparoscopic colorectal surgery (LCS) require reoperation to be treated. However, if the timing to perform this reoperation has some influence on outcome remains elusive. The aim of this study was to analyze if the timing to perform the reoperation has some influence in postoperative outcomes. METHODS A retrospective analysis of patients undergoing LCS and required a reoperation during the period 2000 to 2019 were included. The cohort was divided into 2 groups: early reoperation (ER): ≤48 hours or delayed reoperation (DR): ≥48 hours based on the interval between the suspicion of a complication and reoperation. Demographics, operative variables, and postoperative outcomes were compared between groups. RESULTS A total of 1843 LCS were performed, 68 (43%) were included in ER and 91 (57%) in DR. A computed tomography scan was less frequently performed in the ER (ER: 45% vs. DR: 70%; P=0.001). The rates of re-laparoscopy (ER: 86% vs. 73%; P=0.04) and negative findings in the reoperation (ER: 13% vs. DR: 1%, P=0.001) were higher in ER. There were no statistically significant differences in overall major morbidity (ER: 9% vs. DR: 21%; P=0.06) and mortality rate (ER: 4% vs. DR: 8.7%; P=0.28) between groups. The need of intensive care unit was significantly higher and the length of stay longer for patients in the DR group. CONCLUSIONS Despite a greater risk of negative findings, ER within 48 hours after the suspicion of a complication after a LCS offers higher chances of using a laparoscopic approach and it could probably provide better postoperative outcomes.
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Affiliation(s)
- Nicolas A Rotholtz
- Department of Surgery
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | - Mariano Laporte
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Maximiliano E Bun
- Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
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"Relaparoscopy" to treat early complications following colorectal surgery. Surg Endosc 2021; 36:3136-3140. [PMID: 34159459 DOI: 10.1007/s00464-021-08616-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopic surgery has shown clear benefits that could also be useful in the emergency setting such as early reoperations after colorectal surgery. The aim of this study was to evaluate the safety and feasibility of laparoscopic reintervention ("relaparoscopy") (RL) to manage postoperative complications after laparoscopic colorectal surgery. METHODS We performed a retrospective study based on a prospectively collected database from 2000 to 2019. Patients who required a reoperation after undergoing laparoscopic colorectal surgery were included. According to the approach used at the reoperation, the cohort was divided in laparoscopy (RL) and laparotomy (LPM). Demographics, hospital stay, morbidity, and mortality were analyzed. RESULTS A total of 159 patients underwent a reoperation after a laparoscopic colorectal surgery: 124 (78%) had RL and 35 (22%) LPM. Demographics were similar in both groups. Patients who underwent left colectomy were more frequently reoperated by laparoscopy (RL: 42.7% vs. LPM: 22.8%, p: 0.03). The most common finding at the reoperation was anastomotic leakage, which was treated more often by RL (RL: 67.7% vs. LPM: 25.7%, p: 0.0001), and the most common strategy was drainage and loop ileostomy (RL: 65.8% vs. LPM: 17.6%, p: 0.00001). Conversion was necessary in 12 patients (9.6%). Overall morbidity rate was 52.2%. Patients in the RL group had less postoperative severe complications (RL: 12.1% vs. LPM: 22.8, p: 0.01). Mortality rate was similar in both groups. CONCLUSION Relaparoscopy is feasible and safe for treating early postoperative complications, particularly anastomotic leakage after left colectomy.
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Laparoscopic Versus Open Re-operations Within 30 Days After Lower Gastrointestinal Tract Surgery: a Retrospective Comparative Study. World J Surg 2021; 45:1548-1560. [PMID: 33506293 DOI: 10.1007/s00268-021-05970-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
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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Fransvea P, Costa G, D'Agostino L, Sganga G, Serao A. Redo-laparoscopy in the management of complications after laparoscopic colorectal surgery: a systematic review and meta-analysis of surgical outcomes. Tech Coloproctol 2020; 25:371-383. [PMID: 33230649 DOI: 10.1007/s10151-020-02374-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The laparoscopic approach for colorectal surgery has gradually become widely accepted for the treatment of both benign and malignant diseases thanks to its several advantages over the open approach. However, it is associated with the same potential postoperative complications. Some recent studies have analyzed the potential role of laparoscopy in early diagnosis and management of complications following laparoscopic colorectal surgery. The aim of this systematic review was to investigate the outcomes of redo-laparoscopy (RL) for the management of early postoperative complications following laparoscopic colorectal surgery, focusing on length of stay, morbidity and mortality. METHODS A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines through MEDLINE (PubMed), Embase and Google Scholar from January 1990 to December 2019. The main outcomes examined were conversion rate, length of hospital stay, postoperative morbidity and mortality rates. A meta-analysis of all eligible studies was then conducted and forest plots were generated. RESULTS A total of 19 studies involving 1394 patients who required reoperation after laparoscopic colorectal resection were included. In 539 (38.2%) of these patients, a laparoscopic approach was adopted. The most common indication for returning to the operating theater was anastomotic leakage (64.4% of all redo-surgeries, 67.7% of RL) and the most common type of intervention performed in RL was diverting stoma with or without anastomotic repair/redo (47.1%). Nine studies were included in the pooled analysis. The mean length of stay was significantly shorter in the RL group than in the redo-open one (WMD = - 0.90; 95% CI - 1.04 to - 0.76; Z = - 12,6; p < 0.001). A significantly lower risk of mortality was observed in the RL cohort (OR = - 0.91; 95% CI - 1.58 to - 0.23; Z = - 2.62; p = 0.009). CONCLUSIONS Laparoscopy is a valid and effective approach for the treatment of complications following laparoscopic primary colorectal surgery thanks to it is well-established advantages over the open approach, which remain noticeable even in redo-surgeries.
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Affiliation(s)
- P Fransvea
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - G Costa
- Department of Surgery, University Campus Bio-Medico of Rome, Rome, Italy
| | - L D'Agostino
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - G Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - A Serao
- General Surgery Department, Ospedale Dei Castelli, ASL RM 6, Rome, Italy
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Mari G, Achilli P, Crippa J, Cordaro G, Berardi V, Di Fratta E, Maggioni D. Laparoscopic treatment of diffuse peritonitis for ileocolic anastomotic leak following totally laparoscopic right hemicolectomy. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giulio Mari
- Department of General Surgery Desio Hospital Desio (MB) Italy
| | - Pietro Achilli
- University of Milan, General Surgery Residency Program Milan Italy
| | - Jacopo Crippa
- University of Milan, General Surgery Residency Program Milan Italy
| | - Giuseppe Cordaro
- University of Milan, General Surgery Residency Program Milan Italy
| | - Valter Berardi
- Department of General Surgery Desio Hospital Desio (MB) Italy
| | | | - Dario Maggioni
- Department of General Surgery Desio Hospital Desio (MB) Italy
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8
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Prevalence of internal hernia following laparoscopic colorectal surgery: single-center report on 1300 patients. Surg Endosc 2020; 35:4315-4320. [DOI: 10.1007/s00464-020-07921-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/17/2020] [Indexed: 01/05/2023]
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Pinto RA, Bustamante-Lopez LA, Soares DFM, Nahas CSR, Marques CFS, Cecconello I, Nahas SC. IS LAPAROSCOPIC REOPERATION FEASIBLE TO TREAT EARLY COMPLICATIONS AFTER LAPAROSCOPIC COLORECTAL RESECTIONS? ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2020; 33:e1502. [PMID: 32667532 PMCID: PMC7357554 DOI: 10.1590/0102-672020190001e1502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
Background: Recently, with the performance of minimally invasive procedures for the management of colorectal disorders, it was allowed to extend the indication of laparoscopy in handling various early and late postoperative complications. Aim: To present the experience with laparoscopic reoperations for early complications after laparoscopic colorectal resections. Methods: Patients undergoing laparoscopic colorectal resections with postoperative surgical complications were included and re-treated laparoscopically. Selection for laparoscopic approach were those cases with early diagnosis of complications, hemodynamic stability without significant abdominal distention and without clinical comorbidities that would preclude the procedure. Results: In four years, nine of 290 (3.1%) patients who underwent laparoscopic colorectal resections were re-approached laparoscopically. There were five men. The mean age was 40.67 years. Diagnoses of primary disease included adenocarcinoma (n=3), familial adenomatous polyposis (n=3), ulcerative colitis (n=1), colonic inertia (n=1) and chagasic megacolon (n=1). Initial procedures included four total proctocolectomy with ileal pouch anal anastomosis; three anterior resections; one completion of total colectomy; and one right hemicolectomy. Anastomotic dehiscence was the most common complication that resulted in reoperations (n=6). There was only one case of an unfavorable outcome, with death on the 40th day of the first approach, after consecutive complications. The remaining cases had favorable outcome. Conclusion: In selected cases, laparoscopic access may be a safe and minimally invasive approach for complications of colorectal resection. However, laparoscopic reoperation must be cautiously selected, considering the type of complication, patient’s clinical condition and experience of the surgical team.
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Affiliation(s)
- Rodrigo Ambar Pinto
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Diego Fernandes Maia Soares
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Caio Sergio R Nahas
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Carlos Frederico S Marques
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Sergio Carlos Nahas
- Department of Gastroenterology, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Portale G, Popescu GO, Parotto M, Cavallin F. Internal hernia after laparoscopic colorectal surgery: an under-reported potentially severe complication. A systematic review and meta-analysis. Surg Endosc 2019; 33:1066-1074. [PMID: 30680656 DOI: 10.1007/s00464-019-06671-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Internal hernia following laparoscopic colorectal surgery is often under-reported. The aim of this review was to evaluate the occurrence rate of internal hernia following laparoscopic colorectal surgery, and to describe clinical presentation and management strategies. METHODS A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through April 2018. The review was conducted according to MOOSE guidelines. Quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) tool. Meta-analysis was performed using a random effects model. Studies reporting data on internal hernia after laparoscopic colorectal surgery were included. RESULTS Ten observational studies with a total of 8453 patients were included. All included articles were non-comparative prospective or retrospective cohort studies with an average MINORS score of 8.3 (range 6-11). Summary estimate of proportion of patients developing internal hernia after laparoscopic colorectal resection was 0.5% (95% CI 0.3-0.8%). Heterogeneity was moderate (I2 46%, p = 0.03) and study size (> 1000 vs. <1000 patients) was found to have a significant contribution to heterogeneity (p = 0.002). Thirty patients (90.9%) required surgery, with 5 non-fatal and 3 fatal postoperative complications. Quality of some studies was limited; some patients were followed up for less than 1 year; primary surgical procedures included different laparoscopic approaches. CONCLUSIONS Occurrence rate of internal hernia after laparoscopic colorectal resection is around 5 per 1000 patients. Small-sized studies are likely to overestimate the occurrence of internal hernia. Need for reoperation is high with a substantial risk of mortality.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero 40, 35013, Cittadella, Padua, Italy.
| | - George Octavian Popescu
- Department of General and Visceral Surgery, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Matteo Parotto
- Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
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Chen WTL, Bansal S, Ke TW, Chang SC, Huang YC, Kato T, Wang HM, Fingerhut A. Combined repeat laparoscopy and transanal endolumenal repair (hybrid approach) in the early management of postoperative colorectal anastomotic leaks: technique and outcomes. Surg Endosc 2018; 32:4472-4480. [DOI: 10.1007/s00464-018-6193-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
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12
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Toh JWT, Lim R, Keshava A, Rickard MJFX. The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review. Colorectal Dis 2016; 18:1133-1141. [PMID: 27440227 DOI: 10.1111/codi.13464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/08/2016] [Indexed: 12/28/2022]
Abstract
AIM To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. METHOD Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. RESULTS The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). CONCLUSION Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered.
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Affiliation(s)
- J W T Toh
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - R Lim
- Bankstown Hospital, Bankstown, New South Wales, Australia
| | - A Keshava
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
| | - M J F X Rickard
- Concord Institute of Academic Surgery, Department of Colorectal Surgery, Concord, New South Wales, Australia
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Chang K, Bourke M, Kavanagh D, Neary P, O'Riordan J. A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery. Surgeon 2016; 14:287-93. [DOI: 10.1016/j.surge.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/06/2015] [Accepted: 12/17/2015] [Indexed: 12/15/2022]
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Feigel A, Sylla P. Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis. Clin Colon Rectal Surg 2016; 29:168-180. [PMID: 28642675 PMCID: PMC5477556 DOI: 10.1055/s-0036-1580637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits.
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Affiliation(s)
- Amanda Feigel
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Agrusa A, Frazzetta G, Chianetta D, Di Giovanni S, Gulotta L, Di Buno G, Sorce V, Romano G, Gulotta G. "Relaparoscopic" management of surgical complications: The experience of an Emergency Center. Surg Endosc 2015; 30:2804-10. [PMID: 26490773 DOI: 10.1007/s00464-015-4558-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 09/04/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM Laparotomy has been the approach of choice for re-operations in patients with surgical complications. The aim of this retrospective analysis was to evaluate the feasibility and the safety of laparoscopic approach for the management of general abdominal surgery complications. MATERIALS AND METHODS We report a retrospective review of 75 patients who underwent laparoscopic evaluation for postoperative complications over a 4-year period. Primary outcomes (resolution rate by exclusive laparoscopic approach, conversion rate, further surgery rate) and secondary outcomes (mortality, hospitalization, prolonged ileus, wounds problems and median operative time) were evaluated. RESULTS Sixty-six patients (88 %) were managed with laparoscopic approach without conversion; of these, sixty-three patients (84 %) had no more or further complications and were discharged from hospital between 4 ± 3 days after "second-look" surgery; three patients (4 %) developed postoperative complications requiring a third surgery. Nine cases (12 %) underwent conversion in open surgery after laparoscopic approach. Two elderly patients (2.7 %) died in intensive care unit, because of multi-organ failure syndrome. Median time elapsed between an intervention and another was about 2.5 ± 9.5 days. Mean operative time was 90 ± 150 min. Postoperative hospital stay was between 4.5 and 18 days. DISCUSSION AND CONCLUSION Laparoscopy has begun to be the preferred method to manage postoperative problems, but only few reports are available actually. Our experience in "relaparoscopic" management of surgical complications seems to suggest that laparoscopy "second look" is an effective tool after open or laparoscopic surgery for the management of postoperative complications and it may avoid diagnostic delay and further laparotomy and related problems.
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Affiliation(s)
- Antonino Agrusa
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giuseppe Frazzetta
- Ospedale "Michele Chiello", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n° 4 Contrada Bellia, 94015, Piazza Armerina, Sicily, Italy. .,Ospedale "Umberto I°", Unità Operativa Complessa di Chirurgia Generale e d'Urgenza, ASP n°4, Contrada Ferrante, 94100, Enna, Sicily, Italy.
| | - Daniela Chianetta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Silvia Di Giovanni
- Ospedale "Umberto I°", U.O. Medicina e Chirurgia d'Accettazione e d'Urgenza, ASP n°4, Contrada Ferrante, Enna, 94100, Sicily, Italy
| | - Leonardo Gulotta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giuseppe Di Buno
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Vincenzo Sorce
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Giorgio Romano
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
| | - Gaspare Gulotta
- Dipartimento di Chirurgia Generale e d'Urgenza, Policlinico Universitario "Paolo Giaccone", Palermo, 90121, Sicily, Italy
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Vennix S, Bakker OJ, Prins HA, Lips DJ. Re-interventions following laparoscopic surgery for colorectal cancer: data from 818 individuals from the Dutch surgical colorectal audit. J Laparoendosc Adv Surg Tech A 2015; 24:751-5. [PMID: 25376001 DOI: 10.1089/lap.2014.0385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The surgical procedure of choice for the resection of colorectal cancer has shifted in favor of laparoscopic surgery. Although increasing data prove advantages of elective laparoscopic surgery, less is known about the results in acute indications such as surgical re-interventions following colorectal resections. This study aims to assess the clinical benefits in recovery following laparoscopic re-interventions compared with open re-interventions following laparoscopic colorectal cancer surgery. SUBJECTS AND METHODS We performed an analysis of data from the Dutch Surgical Colorectal Audit from January 2010 to December 2012. All patients requiring surgical re-intervention after initial laparoscopic colorectal surgery were analyzed. RESULTS Out of 27,448 patients, 11,856 underwent laparoscopic surgery. Following laparoscopic surgery, 159 patients (1.3%) had a laparoscopic re-intervention, and 659 patients (5.6%) had an open re-intervention. In a multivariable analysis adjusting for patients' demographics and risk factors, the length of hospital stay was 17 days (interquartile range, 11-16 days) for the laparoscopic group and 23 days (interquartile range, 14-37 days) for the open group (odds ratio [OR]=0.74; 95% confidence interval [CI], 0.65-0.84). In the laparoscopic group the intensive care unit admission rate was 39% compared with 66% in the open group. The 30-day mortality rate was 7 (4%) in the laparoscopic group compared with 89 (14%) in the open group (OR=0.31; 95% CI, 0.13-0.73). CONCLUSIONS Laparoscopic re-intervention following laparoscopic surgery for colorectal cancer is feasible in selected patients. Because of the unknown extent of selection bias, prospective studies are needed to define the exact position and benefits of laparoscopic re-interventions.
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Affiliation(s)
- Sandra Vennix
- Department of Surgery, Jeroen Bosch Hospital , 's-Hertogenbosch, The Netherlands
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Brunner W, Rossetti A, Vines LC, Kalak N, Bischofberger SA. Anastomotic leakage after laparoscopic single-port sigmoid resection: combined transanal and transabdominal minimal invasive management. Surg Endosc 2015; 29:3803-5. [PMID: 25783831 DOI: 10.1007/s00464-015-4138-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 02/21/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic colorectal surgery has become the gold standard in the therapy of benignant and malignant colorectal pathologies. Anastomotic leakage is still a reason for laparotomy; applying a diverting stoma or performing a Hartman's procedure is common [1, 2]. Laparoscopic treatment of an early-detected anastomotic leakage is suggested from other authors [3, 4]. In our video we demonstrate a combined minimal invasive transabdominal and transanal treatment concept in patients with early-detected anastomotic leakage. METHODS Two consecutive patients developing an anastomotic leakage after single-port laparoscopic sigmoid resection for stage II/III diverticulitis (Hanson & Stock) were treated with a combined minimal invasive approach. Anastomotic leakage was diagnosed by triple contrast computed tomography on postoperative day 4 in patient one and on postoperative day 7 in patient two. Operative treatment was performed immediately on the same day without delay. RESULTS In both patients a combined transanal and transabdominal approach was performed. First step was a diagnostic laparoscopy in order to exclude fecal peritonitis. Using a single-port device (SILS Port Covidien), transanal inspection of the anastomosis was also performed: In both patients anastomotic tissue margins were vital, and the leakage affected only a quarter of the anastomotic circumference. Transanal stitches were placed to close the anastomotic leakage. Laparoscopic transabdominal irrigation was performed, and two suction drainages were placed in the pelvis. Postoperative antibiotic treatment and a gradual return to slid food were carried out. Functional result at follow-up of 102 and 112 days (with rectoscopy) showed no residual leak and no stricture of the anastomosis, and both of patients had a normal rectal function.
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Affiliation(s)
- Walter Brunner
- Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland.
| | - Andrea Rossetti
- Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland.
| | - Larissa Clea Vines
- Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland.
| | - Nabil Kalak
- Kantonsspital St. Gallen - Clinic of Surgery, Rorschacherstrasse 95, 9000, St Gallen, Switzerland.
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Cuccurullo D, Pirozzi F, Sciuto A, Bracale U, La Barbera C, Galante F, Corcione F. Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 2014; 29:1795-803. [PMID: 25294542 DOI: 10.1007/s00464-014-3862-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 09/02/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant disease. On the basis of this growing experience, there is now an expanded role for laparoscopic approach to postoperative complications after primary colorectal resection. However, there is little literature specific to this topic. We report a ten-year experience with laparoscopic treatment of early complications following laparoscopic colorectal surgery. METHODS From January 2003 to December 2012, a total of 1,292 patients underwent elective laparoscopic colorectal surgery in our department. One hundred and two (7.9%) patients required reoperation for a postoperative complication. Laparoscopy has been also adopted as the preferred procedure for management of postoperative complications. A retrospective review of 84 patients who had relaparoscopy (RL) for postoperative complications, including peritonitis, ureteral injury, bowel obstruction, and bleeding, was performed. RESULTS Reoperation was carried out laparoscopically in 79 (94.0%) patients. Five (6.0%) conversions were necessary because of massive colonic ischemia, generalized fecal peritonitis, and lack of working space. The most common finding at RL was anastomotic leakage (57.1%) that was managed by peritoneal lavage and ileostomy in 91.7% of cases. Six percent of patients had negative RL. Overall morbidity rate was 25.0%. Five patients required additional surgery: four (5.1%) after RL and one after a converted procedure. There were five (6.0%) deaths from septic shock, myocardial infarction, and pulmonary embolism. CONCLUSIONS Laparoscopy is a safe and effective tool for management of complications following laparoscopic colorectal surgery. In this setting, RL represents the first step of re-exploration and treatment, with no delay to conversion to open procedure even in skilled laparoscopic hands.
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Affiliation(s)
- Diego Cuccurullo
- Department of Laparoscopic and Robotic Surgery, "Azienda Ospedaliera dei Colli" - Monaldi Hospital, Via Leonardo Bianchi s.n.c., 80131, Naples, NA, Italy
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Lee CM, Huh JW, Yun SH, Kim HC, Lee WY, Park YA, Cho YB, Chun HK. Laparoscopic versus open reintervention for anastomotic leakage following minimally invasive colorectal surgery. Surg Endosc 2014; 29:931-6. [PMID: 25060688 DOI: 10.1007/s00464-014-3755-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/10/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study is to evaluate the safety and feasibility of laparoscopic reintervention compared with open surgery in patients with anastomotic leakage after minimally invasive colorectal surgery. METHODS Between January 2008 and December 2012, 77 patients who required surgical reintervention for anastomotic leakage following minimally invasive colorectal surgery were included in this study. Data on the patients' demographics, operative management, morbidity, hospital stay, and mortality were analyzed for differences based on whether they received laparoscopic or open surgery. RESULTS Sixteen patients underwent open surgery following laparoscopy, and 61 patients received laparoscopic reintervention following laparoscopy. The conversion rate was 8.2 % (5/61). The median total hospital stay following reintervention was significantly shorter for laparoscopic surgery (16.0 days, range 9-117 days) than for open surgery (35.5 days, range 10-135 days, p < 0.001). The postoperative 30-day morbidity rate, including wound dehiscence (25.0 vs 3.3 %, p = 0.015) and intra-abdominal infection (31.3 vs 6.6 %, p = 0.016), was lower in the laparoscopic surgery group than in the open surgery group. The rate of stoma closure was lower in the open surgery group than in the laparoscopic surgery group (43.8 vs 80.5 %, p < 0.001). There was one in-hospital mortality in the open surgery group. CONCLUSIONS Laparoscopic reintervention for anastomotic leakage following minimally invasive colorectal surgery is associated with a shorter hospital stay, fewer postoperative complications, and a higher stoma closure rate than open surgery. Laparoscopic reintervention for anastomotic leakage is feasible and safe.
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Affiliation(s)
- Chul Min Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
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