title: Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach.
abstract: To investigate the effect of a laparoscopic approach on the rate of adhesion-related small bowel obstruction (SBO) following colorectal resection.
  
  
  
  Currently, there is little compelling evidence with regard to rates of SBO after laparoscopic versus open abdominal surgery. Few studies have compared risk-adjusted rates of SBO following laparoscopic and open colorectal resection.
  
  
  
  The Statewide Planning and Research Cooperative System was queried for elective colorectal resections in New York State from 2003 to 2010. A propensity score was calculated to account for selection bias between choice of laparoscopic versus open resection. Bivariate and multivariable competing-risks models were constructed to assess patient, hospital, surgeon, and operative characteristics associated with SBO and operation for SBO within 3 years of resection.
  
  
  
  Among 69,303 patients who underwent elective colorectal resection (26% laparoscopic, 74% open), 5.3% of patients developed SBO and 2% of patients underwent an operation for SBO. After controlling for other risk factors and conducting an intention-to-treat analysis, open resection was associated with a higher risk of both SBO [hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.03-1.26] and operation for SBO (HR 1.12, 95% CI 0.94-1.32). This effect was even greater when characterizing laparoscopic-to-open conversions as an open approach (SBO: HR 1.34, 95% CI 1.20-1.49; SBO operation: HR 1.35, 95% CI 1.12-1.63). Most other independent risk factors were nonmodifiable and included age <60, female sex, black race, higher comorbidity burden, previous surgery, inflammatory bowel disease, and procedure type.
  
  
  
  Open colorectal resection increases the risk of SBO compared with laparoscopy. Increased utilization of a laparoscopic approach has the potential to achieve a significant reduction in the incidence of SBO following colorectal resection.
authors.affiliation: Department of Surgery, Surgical Health Outcomes and Research Enterprise (S.H.O.R.E.), University of Rochester Medical Center, Rochester, NY.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Aquina
authors.forename: Christian P
authors.initials: CP
authors.lastname: Probst
authors.forename: Adan Z
authors.initials: AZ
authors.lastname: Becerra
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Hensley
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D003108:Colonic Diseases / Q000601:surgery; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D007813:Laparotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012002:Rectal Diseases / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D000267:Tissue Adhesions / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology