Impact of previous abdominal surgery on the outcome of laparoscopic colectomy: a case-matched control study.
BACKGROUND
Adhesions are a major risk for visceral injury and can increase the difficulty of both laparoscopic and open colectomy. The aim of the present study was to evaluate the impact of previous abdominal surgery on laparoscopic colectomy in terms of early outcome.


METHODS
We performed a case-control study of patients who underwent laparoscopic colectomy for colorectal disease. The case group comprised 91 patients with a history of prior abdominal surgery, while the 91 controls had no such history. Case and controls were matched for age, gender, site of primary disease, comorbidity on admission and body mass index.


RESULTS
The two groups were homogeneous for demographic and clinical characteristics. Conversion rate was 16.5% in the case group and 8.8% in the control group (p=0.18). Of the 7 patients who underwent conversion because of adhesions, six had prior surgery (cases) and one did not (p=0.001). Operative time was 26 minutes longer in the case group than in the control group (p=0.001). Morbidity rate was 25.3% among cases and 23.1% for controls. Patients in the two groups experienced a similar time to recovery of bowel function, length of postoperative stay, and 30-day readmission rate.


CONCLUSIONS
Laparoscopic colectomy in previously operated patients is a time-consuming operation, but it does not appear to affect the short-term postoperative outcome.
Vignali
A
A
Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, I-20132, Milan, Italy. vignali.andrea@hsr.it
Di Palo
S
S
De Nardi
P
P
Radaelli
G
G
Orsenigo
E
E
Staudacher
C
C
D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation; D018709:Statistics, Nonparametric; D000267:Tissue Adhesions / Q000150:complications*; D016896:Treatment Outcome