What influences conversion to open surgery during laparoscopic colorectal resection?

Area of Science:

• Colorectal surgery
• Minimally invasive surgery
• Surgical outcomes

Background:

• Laparoscopic (Lap) surgery is increasingly used for colorectal procedures.
• Conversion to open surgery is sometimes necessary but may impact patient outcomes.
• Assessing the risks associated with conversion is crucial for surgical decision-making.

Purpose of the Study:

• To analyze the morbidity and mortality risks associated with laparoscopic conversion to open surgery in colorectal procedures.
• To compare outcomes of converted laparoscopic procedures with completed laparoscopic and open procedures.
• To provide evidence-based guidance for surgeons performing complex laparoscopic colorectal surgery.

Main Methods:

• Prospective data review of abdominopelvic procedures from 2007-2016 at a tertiary care facility.
• Identification and matching of laparoscopic converted procedures with completed laparoscopic and open procedures.
• Analysis of 30-day outcomes using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) adverse event list.

Main Results:

• Out of 12,454 procedures, 100 were laparoscopic conversions, matched with 339 completed laparoscopic and 305 open procedures.
• Aggregate morbidity was higher in open procedures (33%) compared to laparoscopic converted (29%) and completed laparoscopic (18%) procedures (p < 0.001).
• No significant differences were observed in mortality, sepsis, anastomotic leaks, or reoperations across the groups.

Conclusions:

• While laparoscopic conversion increases morbidity compared to completed laparoscopic surgery, it is still associated with less morbidity than open surgery.
• Increased morbidity in converted cases may be linked to surgical site infections.
• Surgeons should consider the overall benefits of laparoscopic approaches for complex colorectal procedures, even with potential conversion.