Open versus laparoscopic right colectomy: does the initial approach impact on management and outcomein anastomotic...

Anastomotic leakage still represents the most feared complication in colorectal surgery. However, there is limited data focusing on management and how this affects outcome in case of leakage following open versus laparoscopic right colectomy. We, therefore, performed an observational multicenter study addressing this issue.

Data of patients undergoing elective right colectomy for benign and malignant disease using an open or laparoscopic approach were collected in seven colorectal units among Austria between January 2010 and December 2019. Patients undergoing emergency surgery or suffering from Crohn's disease with chronic anastomotic fistula were excluded. Demographic, peri- and postoperative data were analyzed retrospectively.

During the study, a total of 3446 patients were operated on using an open (n = 2282, 66.2%) or laparoscopic (n = 1164, 33.8%) approach. Anastomotic leak rates accounted for 2.8% (65/2281) and 3.2% (37/1165), respectively (p = .588). Age at operation (p < .001), initial surgical approach (open versus laparoscopic; p = .034) and the Mannheim Peritonitis Index (MPI; p < .001) at revision represented independent risk factors for mortality. We divided the surgical strategy during revision into three subgroups: suturing of leak (SD), formation of new anastomosis (NA) or fecal diversion with or without formation of new anastomosis (FD). SD, NA or FD had no influence on clinical outcome and mortality (p = .599). The initial approach had no influence on which strategy was used later, but time to revision was significantly shorter following initial laparoscopic resection (6.2 versus 8.8 days, p = .008). Leak-associated mortality was lower in the minimally invasive group (8.1% vs 23.1%; p = .057).

Timing of revision and not the surgical strategy (± fecal diversion) has an impact on the clinical outcome of patients with a leak following right colectomy. An initial laparoscopic approach may lead to an earlier revision resulting in a lower mortality rate.