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Attempting a Laparoscopic Approach in Patients Undergoing Left-Sided Colorectal Surgery Who Have Had a Previous Laparotomy: Is it Feasible?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The feasibility of a laparoscopic approach in patients who have had a prior laparotomy (PL) remains controversial. We hypothesized that laparoscopic colorectal resection was safe and feasible in patients with previous open abdominal surgery.

Methods

A retrospective review (2007–2015) of all patients undergoing laparoscopic resection for sigmoid and rectal adenocarcinoma with or without prior midline laparotomy (NPL) was performed. Primary endpoints included conversion and perioperative morbidity. Secondary endpoints included length of stay and perioperative outcomes. Demographics, surgical history, oncologic staging, and short-term outcomes were reviewed.

Results

We identified 211 patients, of whom 33 (15.6%) had a prior laparotomy. Significantly more patients in the PL group were female (76.2 vs. 52.8%, p = 0.004). Patients with PL were of similar age to NPL patients (69.3 vs. 62.5, p = 0.09), and comorbidities, tumor staging, and neoadjuvant therapy were comparable between groups (all p > 0.05). Additional trocar placement was significantly higher in PL group (33.3 vs. 17.4%, p = 0.03), while conversion rate did not reach statistical significance (24.2 vs. 12.9%, p = 0.08). The postoperative complication rate was comparable between PL and NPL patients (33.3 vs. 25.3%, respectively, p = 0.2).

Conclusions

Prior laparotomy should not be a contraindication to patients undergoing laparoscopic colorectal surgery, though surgeons should anticipate a higher likelihood of conversion to open.

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References

  1. Jayne DG, Thorpe HC, Copeland J, Quirke P, Brown JM, Guillou PJ (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97:1638–1645. doi: https://doi.org/10.1002/bjs.7160

    Article  CAS  PubMed  Google Scholar 

  2. Bonjer HJ, Deijen CL, Haglind E, Group CIS (2015) A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer. N Engl J Med 373:194. doi: https://doi.org/10.1056/NEJMc1505367

    PubMed  Google Scholar 

  3. Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM, Group CO cancer L or ORS (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484. doi: https://doi.org/10.1016/S1470-2045(05)70221-7

    Article  PubMed  Google Scholar 

  4. Weibel MA, Majno G (1973) Peritoneal adhesions and their relation to abdominal surgery. A postmortem study. Am J Surg 126:345–353.

    Article  CAS  PubMed  Google Scholar 

  5. Beck DE, Ferguson MA, Opelka FG, Fleshman JW, Gervaz P, Wexner SD (2000) Effect of previous surgery on abdominal opening time. Dis Colon Rectum 43:1749–1753.

    Article  CAS  PubMed  Google Scholar 

  6. Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H (2000) Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg 87:467–471. doi: https://doi.org/10.1046/j.1365-2168.2000.01394.x

    Article  Google Scholar 

  7. Figueiredo MN, Campos FG, D’Albuquerque LA, Nahas SC, Cecconello I, Panis Y (2016) Short-term outcomes after laparoscopic colorectal surgery in patients with previous abdominal surgery: A systematic review. World J Gastrointest Surg 8:533–540. doi: https://doi.org/10.4240/wjgs.v8.i7.533

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aytac E, Stocchi L, De Long J, Costedio MM, Gorgun E, Kessler H, Remzi FH (2015) Impact of previous midline laparotomy on the outcomes of laparoscopic intestinal resections: a case-matched study. Surg Endosc 29:537–542. doi: https://doi.org/10.1007/s00464-014-3719-z

    Article  PubMed  Google Scholar 

  9. Vignali A, Di Palo S, De Nardi P, Radaelli G, Orsenigo E, Staudacher C (2007) Impact of previous abdominal surgery on the outcome of laparoscopic colectomy: A case-matched control study. Tech Coloproctol 11:241–246. doi: https://doi.org/10.1007/s10151-007-0358-6

    Article  CAS  PubMed  Google Scholar 

  10. Haksal M, Ozdenkaya Y, Atici AE, Okkabaz N, Aksakal N, Erdemir A, Civil O, Oncel M (2015) Safety and feasibility of laparoscopic sigmoid colon and rectal cancer surgery in patients with previous vertical abdominal laparotomy. Int J Surg 21:97–102. doi: https://doi.org/10.1016/j.ijsu.2015.07.687

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Murad A. Jabir, Justin T. Brady, Yuxiang Wen, Eslam M. G. Dosokey, Dongjin Choi, Sharon L. Stein & Scott R. Steele

  2. Department of Surgical Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

    Murad A. Jabir

  3. Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Conor P. Delaney

  4. Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Scott R. Steele

Authors
  1. Murad A. Jabir
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  2. Justin T. Brady
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  3. Yuxiang Wen
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  4. Eslam M. G. Dosokey
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  5. Dongjin Choi
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  6. Sharon L. Stein
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  7. Conor P. Delaney
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  8. Scott R. Steele
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Contributions

All the above authors meet the following conditions for authorship: (a) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data; (b) drafting the article or revising it critically for important intellectual content; (c) final approval of the version to be published; and (d) agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Scott R. Steele.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

This paper has been presented as a poster presentation at the Midwest Surgical Association Annual Meeting, Mackinac Island, MI. August 7–10, 2016.

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Jabir, M.A., Brady, J.T., Wen, Y. et al. Attempting a Laparoscopic Approach in Patients Undergoing Left-Sided Colorectal Surgery Who Have Had a Previous Laparotomy: Is it Feasible?. J Gastrointest Surg 22, 316–320 (2018). https://doi.org/10.1007/s11605-017-3621-9

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  • DOI: https://doi.org/10.1007/s11605-017-3621-9

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