Laparoscopic colectomy: complications causing reoperation or emergency room/hospital readmissions

The purpose of this study was to determine the incidence of complications causing reoperation or emergency room(ER)/hospital readmission after laparoscopic colectomy (LC). We retrospectively reviewed a prospectively managed database of 358 patients undergoing LC. Nonhand assisted LC was jointly performed by two surgeons assisted by a general surgery resident. Trochar site fascial wounds larger than 5 millimeters were not closed for the first 283 cases, mesenteric defects were not closed. Forty-one patients (11%) required reoperation. Of the 19 hernias (17 incisional, 2 mesenteric), seven caused early postoperative obstructions either within the first week of surgery or within 4 days after discharge. Twelve hernias presented in a delayed fashion and were repaired months later. Eight hernias occurred at trochar sites, nine at specimen extraction sites, and two were in the mesenteric defect. There were eight adhesive small bowel obstructions, five were treated with early reoperation. Other causes included perforations in six cases (2%), anastomotic leak in seven cases (2%) and bleeding in two cases (0.5%). Fifty-nine (16%) separate patients required evaluation in the ER. Fifty-three patients had one ER visit, six patients had two. Causes included nausea and vomiting in 19 cases (5%), wound infection in 16 cases (4%), pain in 13 cases (4%), fever in five cases (1%), thrombosis in four cases (1%); 46 were admitted to the hospital, 70 per cent were discharged within 4 days. Eleven per cent of patients required reoperation after LC, usually for hernias or adhesive small bowel obstruction. Fifty-three per cent of the hernias could have been avoided by routine closure of the fascia. An additional 16 per cent of patients required ER evaluation for complications. Of these, 78 per cent were admitted, 70 per cent were discharged within 4 days. LC is not without potential complications and is not necessarily a less morbid operation.