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Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery

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Open abdominal surgery: a risk factor for future laparoscopic surgery?

Shiva Seetahal¹, Augustine Obirieze¹, Edward E Cornwell¹

¹Department of Surgery, Howard University Hospital, Washington, DC, USA.

American Journal of Surgery

|February 21, 2015

Summary

Laparoscopic surgery after open abdominal surgery, especially with adhesiolysis, is linked to higher complication rates and longer operation times. Further research is needed to understand these risks in patients with prior abdominal surgery.

Keywords:

Complications Laparoscopic surgery Postlaparotomy

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Area of Science:

Surgical outcomes research
Minimally invasive surgery

Background:

Previous open abdominal surgery presents unique challenges for subsequent laparoscopic procedures.
Adhesions from prior surgery can complicate laparoscopic interventions.

Purpose of the Study:

To investigate the outcomes of laparoscopic surgery in patients with a history of open abdominal surgery.
To compare complication rates and operative factors between laparoscopic surgery with and without adhesiolysis.

Main Methods:

Analysis of 162,415 patients from the National Surgical Quality Improvement Program (2005-2009).
Classification of patients based on whether adhesiolysis was performed during laparoscopic procedures (cholecystectomy, Nissen fundoplication, Heller myotomy, splenectomy, Roux-en-Y, sleeve gastrectomy, gastric band, appendectomy, or colectomy).
Bivariate and multivariate analyses to compare outcomes between groups.

Main Results:

4,501 patients (3%) underwent adhesiolysis (AD) alongside laparoscopic surgery.
Patients in the AD group were older and had significantly higher odds of overall complications (41%).
Adhesiolysis was associated with increased adjusted mean operation duration (26%) and lysis of adhesion (17%).

Conclusions:

A history of open abdominal surgery increases complication risk during subsequent laparoscopic procedures.
Adhesiolysis during laparoscopic surgery in patients with prior abdominal surgery is associated with adverse outcomes.
The impact of prior abdominal surgery on laparoscopic outcomes warrants further investigation.