BACKGROUND: Laparoscopic colectomy was considered initially to be contraindicated in patients at high risk for operative morbidity and mortality. We hypothesized that this procedure is safe to perform in high-risk patients, stratifying this risk using National VA Surgical Quality Improvement Program (NSQIP) algorithms. METHODS: A case-matched, comparative study was performed for high-risk veteran patients who underwent colectomy during the period October 2002-September 2004. Consecutive patients undergoing laparoscopic colectomy were matched to patients who underwent open colectomy during the same period for age, body mass index (BMI), procedure, and NSQIP-predicted risk. The groups were compared for risk-stratified, 30-day morbidity/mortality, length of stay (LOS), and operating time. RESULTS: Forty-five patients (23 laparoscopic and 22 open cases) were defined as at high risk for complications (predicted complication >0.15). The rate of major complications was significantly less in the laparoscopic group. There were 4 (18%) cases of postoperative respiratory failure in the open group and none in the laparoscopic group. There was no surgically related mortality in the laparoscopic group, compared with 2 deaths in the open group (P = .5). Median LOS was less in the laparoscopic group (5 days) compared with open (8 days) (P = .001). There were no significant differences in operating time or the number of minor complications. CONCLUSIONS: Our results suggest that the laparoscopic approach to colorectal diseases is safe in the population of patients at high risk for operative morbidity and mortality. Rather, this approach may represent a safer alternative to open access.
BACKGROUND: Laparoscopic colectomy was considered initially to be contraindicated in patients at high risk for operative morbidity and mortality. We hypothesized that this procedure is safe to perform in high-risk patients, stratifying this risk using National VA Surgical Quality Improvement Program (NSQIP) algorithms. METHODS: A case-matched, comparative study was performed for high-risk veteran patients who underwent colectomy during the period October 2002-September 2004. Consecutive patients undergoing laparoscopic colectomy were matched to patients who underwent open colectomy during the same period for age, body mass index (BMI), procedure, and NSQIP-predicted risk. The groups were compared for risk-stratified, 30-day morbidity/mortality, length of stay (LOS), and operating time. RESULTS: Forty-five patients (23 laparoscopic and 22 open cases) were defined as at high risk for complications (predicted complication >0.15). The rate of major complications was significantly less in the laparoscopic group. There were 4 (18%) cases of postoperative respiratory failure in the open group and none in the laparoscopic group. There was no surgically related mortality in the laparoscopic group, compared with 2 deaths in the open group (P = .5). Median LOS was less in the laparoscopic group (5 days) compared with open (8 days) (P = .001). There were no significant differences in operating time or the number of minor complications. CONCLUSIONS: Our results suggest that the laparoscopic approach to colorectal diseases is safe in the population of patients at high risk for operative morbidity and mortality. Rather, this approach may represent a safer alternative to open access.
Authors: Tyler J Loftus; Elisha M Collins; Camille G Dessaigne; Amber N Himmler; Alicia M Mohr; Ryan M Thomas; Charles E Hobson; George A Sarosi; William J Zingarelli Journal: Surg Endosc Date: 2017-04-13 Impact factor: 4.584
Authors: Gabriela Batista Rodríguez; Andrea Balla; Santiago Corradetti; Carmen Martinez; Pilar Hernández; Jesús Bollo; Eduard M Targarona Journal: Int J Colorectal Dis Date: 2018-04-06 Impact factor: 2.571
Authors: David Chen; Naveed Afzal; Sunghwan Sohn; Elizabeth B Habermann; James M Naessens; David W Larson; Hongfang Liu Journal: Surgery Date: 2018-07-20 Impact factor: 3.982
Authors: Celeste Y Kang; Wissam J Halabi; Obaid O Chaudhry; Vinh Nguyen; Noor Ketana; Joseph C Carmichael; Alessio Pigazzi; Michael J Stamos; Steven Mills Journal: J Gastrointest Surg Date: 2012-12-01 Impact factor: 3.452
Authors: Alexandre Bouchard; Guillaume Martel; Elham Sabri; Christopher M Schlachta; Eric C Poulin; Joseph Mamazza; Robin P Boushey Journal: Surg Endosc Date: 2008-07-23 Impact factor: 4.584