Converted laparoscopic colectomy

What are the consequences?
Original Article



The safety and benefits of laparoscopic colon resection are well documented. However, few reports have addressed the safety and comparative outcome of laparoscopic colon operations that necessitated conversion.


All consecutive laparoscopic colon resections performed by a single surgeon from July 1996 to October 2003 were assessed. Data obtained from a prospective computerized database included demographics, diagnosis, reason and time to conversion, length of stay, morbidity, and mortality. Additionally, all laparoscopic-converted colectomies were then matched with open colectomies by diagnosis and severity of disease and analyzed with respect to morbidity, mortality, and clinical outcome.


A total of 143 laparoscopic colon resections were analyzed, 78 of which were left colon resections and 65 were right colon resections. The overall conversion rate was 19.6% (28 patients). The disease entities of the 28 converted patients were diverticulitis (16), polyps (four), Crohn’s disease (three), metastatic cancer (three), and others (two). Conversion was higher in the left-sided (24 patients, 30.8%) versus right-sided (four patients, 6.1%) procedures. There were no differences regarding age, gender, and comorbidities among the laparoscopic, open, and converted groups; the median follow-up was 39 months. The median length of stay was 6, 8, and 12 days for the laparoscopic, open, and converted groups, respectively. Right-sided conversions were due to the size of the inflammatory mass in three patients and intraoperative bleeding in one patient. Left-sided conversions were due to the inflammatory process extending beyond the sigmoid colon in 12 patients, adhesions in five, obesity in four, pericolonic abscess in two, and fixed mass in one patient. Postoperative morbidity was significantly higher for laparoscopic procedures that were converted to open procedures more than 30 min into the operation. Preoperative predictors of conversion were extent of inflammatory process beyond the sigmoid colon and obesity, whereas intraoperative predictors were adhesions and bleeding.


Laparoscopic-converted colon resection is associated with significantly greater morbidity, particularly wound complications and greater length of hospital stay, compared to open or laparoscopic colectomies. Prompt conversion (<30 min) may reduce the overall morbidity associated with converted procedures. Furthermore, thoughtful patient selection may decrease the conversion rate and thereby prevent the inherent morbidity associated with converted procedures.


Laparoscopic colectomy Conversion Morbidity Open colectomy 


  1. 1.
    Nelson H, Sargent DJ, Wieland S, Fleshman J, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, Peters W, Ota D (2004) A comparison of laparoscopic assisted and open colectomy for colon cancer. Clinical Outcome of Surgical Therapy Study Group (COST). N Engl J Med 350: 2050–2059CrossRefGoogle Scholar
  2. 2.
    Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238: 67–72PubMedCrossRefGoogle Scholar
  3. 3.
    Hazebroek EJ, Color Study Group (2002) COLOR: a randomized clinical trial comparing laparoscopic and open resection for colon cancer. Surg Endosc 16: 949–953PubMedCrossRefGoogle Scholar
  4. 4.
    Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs. open colectomy for colon cancer. A randomized trial. J Am Med Assoc 287: 321–328CrossRefGoogle Scholar
  5. 5.
    Gervaz P, Pikarsky A, Utech M, Secic M, Efron J, Belin B, Jain A, Wexner SD (2001) Converted laparoscopic colorectal surgery. Surg Endosc 15: 827–832PubMedCrossRefGoogle Scholar
  6. 6.
    Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart RW (1997) The learning curve for laparoscopic colorectal surgery. Arch Surg 132: 41–44PubMedGoogle Scholar
  7. 7.
    Schwandner O, Schiedeck THK, Bruch HP (1999) The role of conversion in laparoscopic colorectal surgery. Do predictive factors exist? Surg Endosc 13: 151–156PubMedCrossRefGoogle Scholar
  8. 8.
    Marusch F, Gastinger I, Schneider C, Scheidbach H, Konradt J, Bruch HP, Kohler L, Barlehner E, Kockerling F (2001) Importance of conversion for results obtained with laparoscopic colorectal surgery. Dis Colon Rectum 44: 207–214PubMedCrossRefGoogle Scholar
  9. 9.
    Falk PM, Beart RW Jr, Wexner SD, Thorson AG, Jagelman DG, et al. (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36: 28–34PubMedCrossRefGoogle Scholar
  10. 10.
    Hoffman GC, Baker JW, Fitchett CW, Vasant JH (1994) Laparoscopic assisted colectomy. Initial experience. Ann Surg 219: 732–743PubMedGoogle Scholar
  11. 11.
    Le Moine MC, Fabre JM, Vacher C, Navarro F, Picot MC, Domergue J (2003) Factors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease. Br J Surg 90: 232–236PubMedCrossRefGoogle Scholar
  12. 12.
    Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD (1997) Laparoscopic surgery for diverticulitis. Surg Endosc 11: 264–267PubMedCrossRefGoogle Scholar
  13. 13.
    Slim K, Pezet D, Riff Y, Clark E, Chipponi J (1995) High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 82: 1406–1408PubMedGoogle Scholar
  14. 14.
    Pandaya S, Murray JJ, Coller JA, Rusin LC (1999) Laparoscopic colectomy; indications for conversion to laparotomy. Arch Surg 134: 471–475CrossRefGoogle Scholar
  15. 15.
    Schmidt CM, Talamini MA, Kaufman HS, Lilliemoe KD, Learn P, Bayless T (2001) Laparoscopic surgery for Crohn’s disease: reasons for conversion. Ann Surg 233: 733–739PubMedCrossRefGoogle Scholar
  16. 16.
    Phillips EH, Franklin M, Carrol BT, et al. (1992) Laparoscopic colectomy. Ann Surg 216: 703–707PubMedGoogle Scholar
  17. 17.
    Agachan F, Joo JS, Weiss EG, Wexner SD (1996) Intraoperative laparoscopic complications: are we getting better? Dis Colon Rectum 39: S14–S19PubMedCrossRefGoogle Scholar
  18. 18.
    Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW (2004) Does conversion of laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 47: 1680–1685PubMedCrossRefGoogle Scholar
  19. 19.
    Smith EL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, Foley EF (2004) Wound infection after elective colorectal resection. Ann Surg 239: 599–607PubMedCrossRefGoogle Scholar
  20. 20.
    Winslow ER, Fleshman JW, Birnbaum EH, Brunt LM (2002) Wound complications of laparoscopic vs. open colectomy. Surg Endosc 16: 1420–1425PubMedCrossRefGoogle Scholar
  21. 21.
    Lord SA, Larach SW, Ferrara A, et al. (1996) Laparoscopic resection for colorectal carcinoma: a three year experience. Dis Colon Rectum 39: 148–154PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Department of SurgeryLong Island Jewish Hospital, North Shore Long Island Jewish Medical CenterUSA

Personalised recommendations