Implementing protocol-based relaparoscopy for severe complications in laparoscopic colorectal surgery.

Autor: Puccetti F; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy., Vallorani A; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Cinelli L; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Turi S; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy., Gozzini L; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy., Rosati R; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy., Elmore U; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2024 Jun; Vol. 48 (6), pp. 1545-1554. Date of Electronic Publication: 2024 May 08.
DOI: 10.1002/wjs.12200
Abstrakt: Background: Although laparoscopy has demonstrated growing applications for either primary colorectal resections or reoperations, no standardized criteria for implementing laparoscopy in revisional surgery have been reported. This study analyzes a single-center series of major complications after laparoscopic colorectal surgery, undergoing laparoscopic (LR), or open reoperations in compliance with a hemodynamics-based institutional management.
Methods: This study retrospectively analyzes a series of consecutive patients who primarily underwent either laparoscopic left colectomy or low anterior resection in a tertiary referral center between 2016 and 2021. Major complications requiring reoperation (MCR) were managed through an interdisciplinary protocol and submitted to reoperation according to patient hemodynamics and intra-abdominal contamination. A cohort analysis primarily assessed treatment failure rates (i.e., 90-day mortality and need for further surgery), while postoperative morbidity was secondarily examined.
Results: Out of 1137 laparoscopic colorectal resections, 497 patients met eligibility criteria, while 45 (9.1%) developed MCRs were managed according to the standardized interdisciplinary protocol. Revisional surgery was performed through either LR (66.7%) or (33.3%). Treatment failure was 13.3% overall, including additional surgery (11.1%) and 90-day mortality (6.6%) after reoperation. In both overall and anastomotic leak-specific MCRs, relaparoscopy resulted in minimized length of hospital stay, postoperative morbidity, and intensity of care.
Conclusions: Relaparoscopy for MCR preserves clinical benefits related to minimally invasive colorectal surgery. Further studies should investigate applicative determinants and impediments related to the center volume.
(© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
Databáze: MEDLINE
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