Wound complications of laparoscopic vs open colectomy.
BACKGROUND
This study was conducted to determine if laparoscopic colon surgery has changed the incidence of wound complications after colon resection.


METHODS
Eighty-three patients were randomized to undergo either laparoscopic (LCR) or open colon resection (OCR) for cancer at our institution as part of a multicenter trial. Data were tabulated from review of the prospective database and physician records.


RESULTS
Thirty-seven patients were randomized to LCR and 46 to OCR. Seven patients in the LCR group were converted to OCR. LCR was performed using a limited midline incision for anastomosis and specimen extraction. Incision length was significantly greater (p <0.001) in the OCR group (19.4 +/- 5.6 cm) compared to the LCR extraction site (6.3 +/- 1.4 cm). Wound infections occurred in 13.5% of patients after LCR (2.7% trocar, 10.8% extraction sites) and in 10.9% of patients after OCR. Over a mean follow-up period of 30.1 +/- 17.8 months, incisional hernias developed in 24.3% of patients after LCR and 17.4% after OCR. In the LCR group, extraction sites accounted for 85.7% of all wound complications.


CONCLUSIONS
The extraction site for LCR is associated with a high incidence of complications, comparable to open colectomy. Strategies to alter operative technique should be considered to reduce the incidence of these complications.
Winslow
E R
ER
Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 South Euclid, Campus Box 8109, St Louis, MO 63110, USA.
Fleshman
J W
JW
Birnbaum
E H
EH
Brunt
L M
LM
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012811:Sigmoid Neoplasms / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology*