Introduction Clarification as to whether conversion to open surgery during laparoscopic colectomy leads to adverse clinical outcomes when compared to laparoscopic surgery that is completed will help establish if the minimally invasive approach should routinely be attempted in most instances with open surgery reserved for only when this were to fail.
Method The National Surgery Quality Improvement Program 2012 database was used for analysis of patients who underwent laparoscopic colectomy. Patients were categorised into those who completed laparoscopic procedures, who had laparoscopic procedures with conversion to open, and who had open procedures. Analysis was carried out using chi-squared test, fisher exact test, and logistic regression.
Results Of the 16,648 patients included, 7409 (44.50%) underwent open surgery. Of the 9239 who underwent laparoscopic colectomy, 1147 (12.41%) had conversion to open procedure. Strongest association with conversion was found with emergency procedures, preoperative sepsis and septic shock. The other associated factors were male sex, history of CHF, COPD, hypertension, steroid use and disseminated cancer. Post-operatively, compared to the patients who had laparoscopic procedure those who had conversion to open procedure had a higher risk of surgical and medical complications (see Table 1). However, when compared to patients who completed open surgery straightaway, patients who had conversion to open surgery had a higher risk for superficial SSI. While other complications were comparable to open surgery, converted patients had a lower risk of post-operative pneumonia, re-intubation, need for ventilation > 48 h, bleeding that required transfusion, sepsis, septic shock and return to the operating room.
Conclusion While patients who have open conversion have worse outcomes than those who complete laparoscopic colectomy, outcomes for converted patients are not significantly worse than for comparable patients who undergo open surgery straightaway. Considering the benefits of the minimally invasive approach, laparoscopic colectomy may reasonably be attempted in any patient, even when completion may not be assured, with conversion reserved for when this is not feasible.
Disclosure of interest None Declared.
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