Is operative conversion necessary for patients diagnosed with dense adhesions during an elective laparoscopic colectomy?
Laparoscopic colectomy is often complicated by adhesions. Studies examining the morbidity of laparoscopic lysis of adhesions (LOA) combined with colectomy are sparse.


OBJECTIVE
The goal of this study was to prospectively evaluate the results of using the harmonic scalpel to lyse adhesions in patients undergoing laparoscopic colectomy.


METHODS
Laparoscopic colectomy was performed in 83 patients between November 2003 and April 2007. A total of 20 patients underwent laparoscopic colectomy with LOA and 53 patients underwent laparoscopic colectomy alone. Patients were prospectively followed to determine operative time (OT), blood loss, operative conversion, length of stay (LOS), and 30-day morbidity.


RESULTS
Operative conversion was 2%, mean estimated blood loss (EBL) was 95+/-84 mL, and mean OT was 220+/-64 minutes. There were no anastomotic leaks or perioperative mortalities. There were 9 major complications (11%). Patients undergoing laparoscopic colectomy with LOA (n=20) compared with patients undergoing laparoscopic colectomy alone (n=63) had similar conversion rates (5% vs 2%), EBL (115+/-108 vs 88+/-74 mL), and major complications (15% vs 10%), but prolonged minor complications (25% vs 6%) and LOS (6.0+/-3.0 vs 4.6+/-1.5 days).


CONCLUSIONS
Laparoscopic LOA combined with colectomy leads to similar conversion rates and major morbidity compared to laparoscopic colectomy alone.
Blumberg
David
D
University of Pittsburgh Medical Center and Bandaid Surgery, Pittsburgh, Pennsylvania 15232, USA. davidsurg@aol.com