Is there a role for a strict incision length criterion for determining conversions during laparoscopic colorectal resection?
OBJECTIVE
There's no consensus about what defines a conversion for laparoscopic-assisted colorectal resection (LACR). This study's goal was to assess the utility of a strict incision length (IL) definition of conversion (incision > 7 cm) and compare it with results obtained when the surgeon determined (SD) if a LACR had been successfully completed.


METHODS
The demographic and perioperative data for 580 elective LACRs were reviewed. The short-term outcomes for each conversion definition were determined and compared.


RESULTS
Conversion rates were 22% using the IL definition and 16% via the SD method. Both methods detected significant differences between completed and converted groups regarding the following: incision size, hospital stay, time to flatus, bowel movement, and regular diet as well as rate of wound infection and ileus. The IL method alone detected significant differences in the rate of pulmonary complications and BMI between the completed and converted groups.


CONCLUSIONS
The 2 methods yielded similar results for most parameters. The IL method better separated the patients in regard to 2 parameters. This method is objective and easy to apply; however, it may discriminate against obese patients whose extraction incisions are often longer. A conversion definition that considers BMI and IL is needed.
Offodile
Anaeze C
AC
New York-Presbyterian Hospital, Columbia Campus, New York, NY 10032, USA.
Balik
Emre
E
Hoffman
Aviad
A
Moon
Victor
V
Baxter
Raymond
R
Grieco
Michael
M
Moradi
Dovid
D
Kim
Ik-yong
IY
Nasar
Abu
A
Cekic
Vesna
V
Feingold
Daniel L
DL
Arnell
Tracey D
TD
Huang
Emina
E
Whelan
Richard L
RL
D034861:Abdominal Wall / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015992:Body Mass Index; D003082:Colectomy / Q000379:methods*; D003657:Decision Making; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D018579:Patient Selection; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies