Ureteral injury after laparoscopic versus open colectomy.
OBJECTIVE
Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury.


METHODS
We analyzed data from the National Surgical Quality Improvement Program for the years 2005-2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury.


RESULTS
Of a total of 94,526 colectomies, 33,092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P=.016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51-0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury.


CONCLUSIONS
Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy.
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Syed Nabeel
SN
Zafar
Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC, USA.
Chiledum A
CA
Ahaghotu
School of Medicine, Howard University, Washington, DC, USA.
Laura
L
Libuit
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Gezzer
G
Ortega
Division of Urology, Department of Surgery, Howard University Hospital, Washington, DC, USA.
Pamela W
PW
Coleman
Department of Surgery, Howard University Hospital, Washington, DC, USA.
Edward E
EE
Cornwell
Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Howard University Hospital, Washington, DC, USA.
Daniel D
DD
Tran
Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Howard University Hospital, Washington, DC, USA.
Terrence M
TM
Fullum
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014513:Ureter / Q000293:injuries*; D055815:Young Adult
Coarsened exact matching; Colon resection; Iatrogenic injury; Laparoscopic surgery; Ureteral injury