Laparoscopic Colectomy: Complications Causing Reoperation or Emergency Room/Hospital Readmissions

The purpose of this study was to determine the incidence of complications causing reoperation or emergency room(ER)/hospital readmission after laparoscopic colectomy (LC). We retrospectively reviewed a prospectively managed database of 358 patients undergoing LC. Nonhand assisted LC was jointly performed by two surgeons assisted by a general surgery resident. Trochar site fascial wounds larger than 5 millimeters were not closed for the first 283 cases, mesenteric defects were not closed. Forty-one patients (11%) required reoperation. Of the 19 hernias (17 incisional, 2 mesenteric), seven caused early postoperative obstructions either within the first week of surgery or within 4 days after discharge. Twelve hernias presented in a delayed fashion and were repaired months later. Eight hernias occurred at trochar sites, nine at specimen extraction sites, and two were in the mesenteric defect. There were eight adhesive small bowel obstructions, five were treated with early reoperation. Other causes included perforations in six cases (2%), anastomotic leak in seven cases (2%) and bleeding in two cases (0.5%). Fifty-nine (16%) separate patients required evaluation in the ER. Fifty-three patients had one ER visit, six patients had two. Causes included nausea and vomiting in 19 cases (5%), wound infection in 16 cases (4%), pain in 13 cases (4%), fever in five cases (1%), thrombosis in four cases (1%); 46 were admitted to the hospital, 70 per cent were discharged within 4 days. Eleven per cent of patients required reoperation after LC, usually for hernias or adhesive small bowel obstruction. Fifty-three per cent of the hernias could have been avoided by routine closure of the fascia. An additional 16 per cent of patients required ER evaluation for complications. Of these, 78 per cent were admitted, 70 per cent were discharged within 4 days. LC is not without potential complications and is not necessarily a less morbid operation.

[1]  S. Nagayama,et al.  Risk Factors for Complications After Laparoscopic Surgery in Colorectal Cancer Patients: Experience of 401 Cases at a Single Institution , 2009, World Journal of Surgery.

[2]  K. Leung,et al.  The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit , 2009, Surgical Endoscopy.

[3]  G. Portale,et al.  Laparoscopic colon resection by a single general surgeon in a community hospital: a review of 200 consecutive cases. , 2009, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[4]  Kyoung-Hoon Lim,et al.  Multidimensional analysis of the learning curve for laparoscopic colorectal surgery: lessons from 1,000 cases of laparoscopic colorectal surgery , 2009, Surgical Endoscopy.

[5]  P. Kirchhoff,et al.  A Multivariate Analysis of Potential Risk Factors for Intra- and Postoperative Complications in 1316 Elective Laparoscopic Colorectal Procedures , 2008, Annals of surgery.

[6]  C. McKinley,et al.  Does the extraction-site location in laparoscopic colorectal surgery have an impact on incisional hernia rates? , 2008, Surgical Endoscopy.

[7]  C. Delaney.  Outcome of Discharge Within 24 to 72 Hours After Laparoscopic Colorectal Surgery , 2008, Diseases of the colon and rectum.

[8]  P. O’Dwyer,et al.  Laparoscopic colorectal resection does not reduce incisional hernia rates when compared with open colorectal resection , 2008, Surgical Endoscopy.

[9]  A. Senagore,et al.  Predictors and Outcome of Readmission after Laparoscopic Intestinal Surgery , 2007, World Journal of Surgery.

[10]  A. Senagore,et al.  A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. , 2006, American journal of surgery.

[11]  A. Senagore,et al.  Multivariable analysis of factors associated with hospital readmission after intestinal surgery. , 2006, American journal of surgery.

[12]  R. Aft,et al.  Perioperative outcomes and complications of laparoscopic ventral hernia repair. , 2005, Surgery.

[13]  M. Bloomston,et al.  Surgical management of colorectal cancer in the laparoscopic era: a review of prospective randomized trials. , 2005, Journal of the National Comprehensive Cancer Network : JNCCN.

[14]  A. Arrigoni,et al.  Outcome of laparoscopic colorectal resection , 2004, Surgical Endoscopy And Other Interventional Techniques.

[15]  J. Fleshman,et al.  Wound complications of laparoscopic vs open colectomy , 2002, Surgical Endoscopy And Other Interventional Techniques.

[16]  M. Guerrieri,et al.  Laparoscopic vs open hemicolectomy for colon cancer , 2002, Surgical Endoscopy.

[17]  M. Stamos,et al.  A Case-Control Study of Laparoscopic versus Open Sigmoid Colectomy for Diverticulitis , 2000, The American surgeon.

[18]  C. Vons,et al.  Elective laparoscopic sigmoid colectomy for diverticulitis , 1999, Surgical Endoscopy.

[19]  D. Seidman,et al.  Incisional hernias after operative laparoscopy. , 1997, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[20]  H. Reich,et al.  Incisional hernias after major laparoscopic gynecologic procedures. , 1993 .