title: A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection.
abstract: BACKGROUND
  Reduction in length of stay has several advantages, including healthcare costs, patient choice, and minimizing hospital acquired infections. Additionally, length of stay is a surrogate marker of rate of recovery from the physiological insult of anaesthesia and surgery and complications thereof. A well-documented short-term benefit of laparoscopic compared to open colorectal resection is reduced length of stay.
  
  
  METHODS
  This was a review of prospectively collected data on all laparoscopic colorectal resections performed in our unit. We analyzed patients having primary colorectal anastomosis, to assess the effect of conversion compared to completion laparoscopically. Furthermore we compared those with or without diverting stoma, for the effect of stoma formation on postoperative length of stay (LOS).
  
  
  RESULTS
  Two hundred and thirteen patients had a colorectal resection. Of these 133 (62%) were left-sided or rectal resections. Resection with primary colorectal anastomosis was undertaken in 112 patients. A defunctioning stoma was performed in 13/112 (12%), and 32/112 (29%) were converted as the procedure could not be completed laparoscopically. Conversion was not significantly associated with increased LOS with weighted median of 6.5 and 6 days for conversion and no conversion, respectively. However, stoma formation significantly increased LOS to a median of 10 days compared with a median of 6 days in patients without a stoma (p = 0.001, Mann-Whitney U).
  
  
  CONCLUSIONS
  The need for conversion, if performed in a timely and appropriate manner, has little impact on patient outcome compared to those completed laparoscopically, with no significant increase in LOS in our experience. In contrast, a diverting stoma does prolong LOS and some of the benefits of laparoscopic surgery may be lost unless patients requiring a stoma are identified preoperatively and have intensive pre- and postoperative stoma training.
authors.affiliation: Department of Colorectal Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, RG24 9NA, UK. markcartmell@hotmail.com
authors.forename: Mark T
authors.initials: MT
authors.lastname: Cartmell
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Jones
authors.forename: B J
authors.initials: BJ
authors.lastname: Moran
authors.forename: T D
authors.initials: TD
authors.lastname: Cecil
mesh_terms: D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery; D004240:Diverticulum / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D054047:Surgical Stomas