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Laparoscopic colectomy: indications for conversion to laparotomy.

S Pandya1, J J Murray, J A Coller

  • 1Department of General Surgery, Lahey Clinic, Burlington, Mass 01805, USA.

Archives of Surgery (Chicago, Ill. : 1960)
|May 14, 1999
PubMed
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Laparoscopic colectomy conversion rates decreased with experience. Technical limitations like tumor bulk and adhesions, not patient selection, now drive conversions to open surgery.

Area of Science:

  • Colorectal surgery
  • Minimally invasive surgery

Background:

  • Laparoscopic colectomy is increasingly used, but patient selection criteria are lacking.
  • Understanding conversion reasons can inform selection criteria for laparoscopic colon and rectal surgery.

Purpose of the Study:

  • To identify technical limitations of laparoscopic colectomy by analyzing reasons for conversion to laparotomy.
  • To provide data that may facilitate the development of patient selection criteria for laparoscopic colorectal procedures.

Main Methods:

  • Retrospective review of medical records for 200 patients who underwent laparoscopic colon surgery.
  • Analysis of conversion indications in 47 patients converted to laparotomy.

Main Results:

  • The overall conversion rate decreased over time.

Related Experiment Videos

  • Indications for conversion were primarily technical issues (e.g., unclear anatomy, stapler misfire), laparoscopic complications (e.g., bleeding), and limitations of dissection (e.g., adhesions, tumor bulk, obesity).
  • Segmental resections had lower conversion rates than other procedures.

    • Conclusions:

    • Conversion to laparotomy is now mainly due to technical limitations exceeding laparoscopic capabilities, such as extensive adhesions or large tumors.
    • Laparoscopic colorectal reanastomosis and distal rectal resections remain challenging.
    • Obesity is a less frequent cause of conversion than previously thought.