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Journal of Gastrointestinal Surgery

, Volume 21, Issue 4, pp 684–691 | Cite as

Hand-Assisted Laparoscopic Colectomy Improves Perioperative Outcomes Without Increasing Operative Time Compared to the Open Approach: a National Analysis of 8791 Patients

  • Harold J. LeraasEmail author
  • Cecilia T. Ong
  • Zhifei Sun
  • Mohamed A. Adam
  • Jina Kim
  • Brian F. Gilmore
  • Brian Ezekian
  • Uttara S. Nag
  • Christopher R. Mantyh
  • John Migaly
Original Article

Abstract

Introduction

Hand-assisted laparoscopic surgery (HALS) is often used in procedures too complex for completely minimally invasive approaches. However, there are concerns for whether this hybrid approach abrogates perioperative benefits of the completely minimally invasive technique.

Methods

We queried the 2012–2013 National Surgery Quality Improvement Program for adults undergoing elective HALS or open colectomy (OC). After propensity matching, short-term outcomes were compared. Subset analysis was performed for segmental resections. Multivariate analysis was used to determine predictors of utilizing either approach.

Results

This query included 8791 patients (OC 2707, HALS 6084). Predictors of HALS included male sex (OR 1.17, p = 0.006), increasing BMI (OR 1.01, p = 0.02), benign indication (OR 1.48, p < 0.001), and total abdominal colectomy (OR 10.39, p < 0.001). Younger age, black race, ASA class ≥3, inflammatory bowel disease, and low pelvic anastomosis were predictive of OC (all p < 0.05). HALS demonstrated reduced overall complications (p < 0.001), wound complications (p < 0.001), anastomotic leak (p = 0.014), transfusion (p < 0.001), postoperative ileus (p < 0.001), length of stay (p < 0.001), and readmission (p < 0.001) without increased operative time. For segmental resection, HALS demonstrated reduced overall complications, wound complications, respiratory complications, postoperative ileus, anastomotic leak, transfusion, length of stay, and readmissions (all p < 0.05).

Conclusions

Compared to OC, HALS demonstrates improved perioperative outcomes without increased operative time.

Keywords

Colorectal surgery Hand-assisted laparoscopic surgery Minimally invasive surgery Outcomes 

Abbreviations

NSQIP

National Surgical Quality Improvement Program

HALS

Hand-assisted laparoscopic surgery

Notes

Author’s Contribution

All authors meet the definition of authorship as outlined by ICMJE in that all made substantial contribution to the design of the study or interpretation of data, drafted or revised the work, had final approval of this submission, and agree to be accountable for this work.

Compliance with Ethical Standards

Financial Disclosures

None

Disclosures

These data were presented as an oral presentation at the 11th Academic Surgical Congress on February 2nd, 2016. The data used in this study are derived from a de-identified NSQIP file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.

Grant Support

None.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Harold J. Leraas
    • 1
    Email author
  • Cecilia T. Ong
    • 1
  • Zhifei Sun
    • 1
  • Mohamed A. Adam
    • 1
  • Jina Kim
    • 1
  • Brian F. Gilmore
    • 1
  • Brian Ezekian
    • 1
  • Uttara S. Nag
    • 1
  • Christopher R. Mantyh
    • 1
  • John Migaly
    • 1
  1. 1.Department of SurgeryDuke University Medical CenterDurhamUSA

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