title: Surgical re-interventions following colorectal surgery: open versus laparoscopic management of anastomotic leakage.
abstract: BACKGROUND
  Increasing numbers of colorectal resections are performed laparoscopically each year. In 2010, 42% of all colorectal procedures in The Netherlands were performed laparoscopically. Although the anastomotic leakage rate is 3%-19% of all patients, little is known about laparoscopic options for re-intervention. Our study aims to evaluate the safety and feasibility of laparoscopic re-intervention compared with open surgery following colorectal surgery.
  
  
  METHODS
  All patients who required a surgical re-intervention for an anastomotic leak, bowel perforation, or abscess after laparoscopic colorectal surgery between January 2008 and June 2012 were analyzed retrospectively. Demographic data, operative management, morbidity, hospital stay, and mortality were collected and analyzed for each patient.
  
  
  RESULTS
  Fifty-six patients were included. Eighteen patients had a laparotomy following laparoscopy, and 38 patients had a laparoscopic re-intervention following laparoscopy. The median age was 65 years, with a median body mass index of 26 kg/m(2). Four patients had a previous laparotomy, and 73% had surgery for malignant colorectal disease. The length of hospital stay was 20 days in the laparoscopic group versus 31 days in the open group (P=.044). Six out of 38 versus 7 out of 18 patients required an additional re-intervention (P=.056). Fewer patients developed fascial dehiscence in the laparoscopic group (P=.033). In-hospital mortality was 4 out of 18 in the open group compared with 2 out of 38 in the laparoscopic group (P=.077).
  
  
  CONCLUSIONS
  Laparoscopic re-intervention could be a safe and feasible treatment for anastomotic leakage after laparoscopic colorectal surgery. These promising results need to be further investigated in a prospective study to reduce uncertainty in the patient's condition and perioperative findings.
authors.affiliation: Department of Surgical Oncology and Gastrointestinal Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Vennix
authors.forename: Raoul
authors.initials: R
authors.lastname: Abegg
authors.forename: Olaf J
authors.initials: OJ
authors.lastname: Bakker
authors.forename: Peter B
authors.initials: PB
authors.lastname: van den Boezem
authors.forename: Walter J A
authors.initials: WJ
authors.lastname: Brokelman
authors.forename: Colin
authors.initials: C
authors.lastname: Sietses
authors.forename: Koop
authors.initials: K
authors.lastname: Bosscha
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lips
authors.forename: Hubert A
authors.initials: HA
authors.lastname: Prins
mesh_terms: D000038:Abscess / Q000601:surgery; D000368:Aged; D057868:Anastomotic Leak / Q000601:surgery*; D003107:Colorectal Surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome