"Relaparoscopy" to treat early complications following colorectal surgery

Laparoscopic surgery has shown clear benefits that could also be useful in the emergency setting such as early reoperations after colorectal surgery. The aim of this study was to evaluate the safety and feasibility of laparoscopic reintervention ("relaparoscopy") (RL) to manage postoperative complications after laparoscopic colorectal surgery.

We performed a retrospective study based on a prospectively collected database from 2000 to 2019. Patients who required a reoperation after undergoing laparoscopic colorectal surgery were included. According to the approach used at the reoperation, the cohort was divided in laparoscopy (RL) and laparotomy (LPM). Demographics, hospital stay, morbidity, and mortality were analyzed.

A total of 159 patients underwent a reoperation after a laparoscopic colorectal surgery: 124 (78%) had RL and 35 (22%) LPM. Demographics were similar in both groups. Patients who underwent left colectomy were more frequently reoperated by laparoscopy (RL: 42.7% vs. LPM: 22.8%, p: 0.03). The most common finding at the reoperation was anastomotic leakage, which was treated more often by RL (RL: 67.7% vs. LPM: 25.7%, p: 0.0001), and the most common strategy was drainage and loop ileostomy (RL: 65.8% vs. LPM: 17.6%, p: 0.00001). Conversion was necessary in 12 patients (9.6%). Overall morbidity rate was 52.2%. Patients in the RL group had less postoperative severe complications (RL: 12.1% vs. LPM: 22.8, p: 0.01). Mortality rate was similar in both groups.

Relaparoscopy is feasible and safe for treating early postoperative complications, particularly anastomotic leakage after left colectomy.