title: Laparoscopic colorectal anastomosis: risk of postoperative leakage. Results of a multicenter study. Laparoscopic Colorectal Surgery Study Group (LCSSG).
abstract: BACKGROUND
  We report on a prospective observational multicenter study of more than 1,000 consecutive patients undergoing laparoscopic colorectal procedures. The aim of the current study was to investigate the safety of laparoscopic colorectal surgery as reflected by the anastomotic insufficiency rates in the various sections of the bowel, and to compare these rates with those of open colorectal surgery.
  
  
  METHODS
  The study was begun on August 1, 1995. Twenty-four centers in Germany, Austria, and Switzerland participated in this prospective multicenter study. All patients undergoing laparoscopic colorectal surgery were included in the study. No selection criteria were applied, which means that every operation begun as a laparoscopic procedure was included. Data on patient demographics, surgical indications, surgical course, and patient outcome were recorded prospectively in a computer database. All data were rendered anonymous.
  
  
  RESULTS
  Between August 1995 and February 1998, the 24 participating centers treated 1,143 patients (male/female ratio, 1:1.36; mean age, 60.7 years). In all, 626 operations were performed for benign indications and 517 for cancer. Most procedures involved the sigmoid colon and rectum (80.9%). An anastomosis was performed in 83% of the operations. Most of the anastomoses were laparoscopically assisted using the stapling technique. We observed an overall leakage rate of 4.25% (colon 2.9%; rectum 12.7%), and surgical reintervention was required in 1% of the cases. The rate of conversion to open surgery was 5.6%. Intraoperative complications occurred in 5.9%, and reoperation was necessary in 4.1% of the cases. The overall morbidity rate was 22.3%, and the 30-day mortality rate was 1.57%.
  
  
  CONCLUSIONS
  The feasibility and safety of the laparoscopic colorectal approach is demonstrated clearly. The current study shows that the laparoscopic or laparoscopically assisted approach to colorectal surgery is not associated with a higher risk of anastomotic leaks. Morbidity and mortality rates with this method approximate those seen with conventional colorectal surgery.
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Hanover Hospital, Academic Hospital Medical High School Hanover, Roesebeckstrasse 15 (Siloah), D-30449 Hannover, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Köckerling
authors.forename: J
authors.initials: J
authors.lastname: Rose
authors.forename: C
authors.initials: C
authors.lastname: Schneider
authors.forename: H
authors.initials: H
authors.lastname: Scheidbach
authors.forename: H
authors.initials: H
authors.lastname: Scheuerlein
authors.forename: M A
authors.initials: MA
authors.lastname: Reymond
authors.forename: T
authors.initials: T
authors.lastname: Reck
authors.forename: J
authors.initials: J
authors.lastname: Konradt
authors.forename: H P
authors.initials: HP
authors.lastname: Bruch
authors.forename: C
authors.initials: C
authors.lastname: Zornig
authors.forename: E
authors.initials: E
authors.lastname: Bärlehner
authors.forename: A
authors.initials: A
authors.lastname: Kuthe
authors.forename: G
authors.initials: G
authors.lastname: Szinicz
authors.forename: H A
authors.initials: HA
authors.lastname: Richter
authors.forename: W
authors.initials: W
authors.lastname: Hohenberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D016009:Chi-Square Distribution; D003108:Colonic Diseases / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome