title: The role of laparoscopic approach for anastomotic leakage after minimally invasive surgery for colorectal cancer.
abstract: OBJECTIVE
  The objectives of this study were to evaluate the feasibility and safety of a re-laparoscopic approach to manage anastomotic leakage after minimally invasive colorectal resection and to compare its clinical outcomes with those obtained using an open approach.
  
  
  METHODS
  We retrospectively reviewed clinical data from 1714 patients who underwent colorectal cancer resection from September 2006 to August 2009 at the Korea University Medical Center. Clinical data from a total of 57 surgery patients who developed anastomotic leakage were analyzed.
  
  
  RESULTS
  Twenty-six leakage cases were managed laparoscopically, whereas the remaining 31 leakage cases were managed using an open approach. There were no significant differences in age, sex, or other clinical features between patients in the two groups. The total operation time was shorter in the laparoscopic group (107.3 ± 68.1 minutes) than in the open group (126.5 ± 50.1 minutes), but this difference was not statistically significant (P = .230). Six cases in each group required additional procedures such as reoperation or percutaneous intervention (P = .126). There was one case of postoperative mortality in the open group. Median (quartiles 25%-75%) number of days required to resume a soft diet tended to be shorter in the laparoscopic group than the open group (5 [3-7] versus 6 [5-10] days; P = .057). Patients in both groups showed similar postoperative complications including intraabdominal abscess; however, the incidence of wound infection was significantly lower in the laparoscopic group than the open group (3.8% versus 25.8%; P = .031).
  
  
  CONCLUSIONS
  Compared with conventional open treatment of anastomotic leakage, the laparoscopic approach resulted in fewer wound complications and tendency of early recovery of bowel movement without an increase in adverse outcomes. Using a laparoscopic approach, all the advantages of minimally invasive surgery can be realized in patients who develop anastomotic leakage after minimally invasive surgery.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seoul, Korea.
authors.forename: Jung Myun
authors.initials: JM
authors.lastname: Kwak
authors.forename: Seon Hahn
authors.initials: SH
authors.lastname: Kim
authors.forename: Dong Nyoung
authors.initials: DN
authors.lastname: Son
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Sun Il
authors.initials: SI
authors.lastname: Lee
authors.forename: Byung Wook
authors.initials: BW
authors.lastname: Min
authors.forename: Jun Won
authors.initials: JW
authors.lastname: Um
authors.forename: Hong Young
authors.initials: HY
authors.lastname: Moon
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D057868:Anastomotic Leak / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013530:Surgical Wound Infection