Impact of previous midline laparotomy on the outcomes of laparoscopic intestinal resections: a case-matched study

The effectiveness of laparoscopic intestinal resection in patients with previous midline laparotomy (PML) is controversial. The aim of this study was to assess the feasibility of laparoscopic surgery and identify possible factors associated with postoperative outcomes in patients with PML. Patients with PML (at least an infraumbilical incision or longer) undergoing elective laparoscopic intestinal resection between 1997 and 2011 were case matched with patients without PML undergoing laparoscopic surgery based on age, gender, body mass index, ASA score, surgical procedure, and diagnosis. Fifty patients with PML undergoing laparoscopic intestinal resection were well matched to 50 counterparts. Conversion to open surgery (n = 8 vs. n = 4, p = 0.22), operating time (211 vs. 192 min, p = 0.22), and estimated blood loss (158 vs. 184 ml, p = 0.95) were similar between the groups. Intraabdominal adhesions (either disease related or from previous operations) were significantly more common in patients with PML (n = 24 vs. n = 11, p = 0.01). Intraoperative complications included inadvertent enterotomy and hemorrhage and were comparable between the groups (n = 1 vs. n = 0, p = 1 and n = 1 vs. n = 2, p = 1 for PML vs. no PML, respectively). One patient without PML died postoperatively from aspiration pneumonia. Overall morbidity (n = 26 vs. n = 10, p = 0.001) and particularly postoperative ileus (n = 10 vs. n = 3, p = 0.04) were significantly increased in the PML group when compared to laparoscopy without PML, unlike the respective differences in postoperative return of bowel function (4 vs. 3 days, p = 0.15), reoperations (n = 5 vs. n = 3, p = 0.72), length of hospital stay (9 vs. 6 days, p = 0.09), and readmissions (n = 5 vs. n = 4, p = 0.73). Intestinal resections in patients with PML can be frequently completed laparoscopically but are associated with worse postoperative outcomes when compared to laparoscopy on a virgin abdomen.