Diseases of the Colon & Rectum

, Volume 44, Issue 2, pp 207–214 | Cite as

Importance of conversion for results obtained with laparoscopic colorectal surgery

  • Frank Marusch
  • Ingo Gastinger
  • Claus Schneider
  • Hubert Scheidbach
  • Jochen Konradt
  • Hans-Peter Bruch
  • Lothar Köhler
  • Eckhard Bärlehner
  • Ferdinand Köckerling
  • the Laparoscopic Colorectal Surgery Study Group (LCSSG)
Original Contributions


PURPOSE: The need for a conversion is a problem inherent in laparoscopic surgery. The present study points up the significance of conversion for the results obtained with laparoscopic colorectal surgery and identifies the risk factors that establish the need for conversion. METHOD: The study took the form of a multicentric, prospective, observational study within the Laparoscopic Colorectal Surgery Study Group. A total of 33 institutions in Germany, Austria, and Switzerland participated. The study period was 3.5 years. Cases were documented with the aid of a standardized questionnaire. RESULTS: Within the framework of the Laparoscopic Colorectal Surgery Study Group, a total of 1,658 patients were recruited to a multicenter study over a period of three and one-half years (from August 1, 1995 to February 1, 1999). The observed conversion rate was 5.2 percent (n=86). The patients requiring a conversion were significantly heavier (body mass index, 26.5vs. 24.9) than those undergoing pure laparoscopy. Resections of the rectum were associated with a higher risk for conversion (20.9vs. 13 percent). Intraoperative complications occurred significantly more frequently in the conversion group (27.9vs. 3.8 percent). The duration of the operation was significantly increased after conversion in a considerable proportion of the procedures performed. Postoperative morbidity (47.7vs. 26.1 percent), mortality (3.5vs. 1.5 percent), recovery time, and postoperative hospital stay were all negatively influenced by conversion, in part significantly. Institutions with experience of more than 100 laparoscopic colorectal procedures proved to have a significantly lower conversion rate than those with experience of fewer than 100 such interventions (4.3vs. 6.9 percent). CONCLUSION: Although, of itself, conversion is not considered to be a complication of laparoscopic surgery, it is true that the postoperative course after conversion is associated with appreciably poorer results in terms of morbidity, mortality, convalescence, blood transfusion requirement, and postoperative hospital stay. The importance of experience in laparoscopic surgery can be demonstrated on the basis of the conversion rates. Careful patient selection oriented to the experience of the surgeon is required if we are to keep the conversion, morbidity, and mortality rates of laparoscopic colorectal procedures as low as possible.

Key words

Multicenter study Laparoscopic colorectal surgery Conversion Learning curve Experience 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Schirmer BD. Laparoscopic colon resection. Surg Clin North Am 1996;76:571–83.CrossRefPubMedGoogle Scholar
  2. 2.
    Christen D, Buchmann P. Sources of hazards in laparoscopic colon surgery and how to avoid them [in German]. Swiss Surg 1996;2:203–7.PubMedGoogle Scholar
  3. 3.
    Ballantyne GH. Laparoscopic-assisted colorectal surgery: review of results in 752 patients. Gastroenterologist 1995;3:75–89.PubMedGoogle Scholar
  4. 4.
    Gellman L, Salky B, Edye M. Laparoscopic assisted colectomy. Surg Endosc 1996;10:1041–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Bennett CL, Stryker SJ, Fereira MR, Adams J, Beart RW Jr. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 1997;132:41–5.PubMedGoogle Scholar
  6. 6.
    Bruch H, Schiedeck Th, Schwandner O. Laparoscopic colorectal surgery: a five-year experience. Dig Surg 1999;16:45–54.CrossRefPubMedGoogle Scholar
  7. 7.
    Fielding GA, Lumley J, Nathanson L, Hewitt P, Rhodes M, Stitz R. Laparoscopic colectomy. Surg Endosc 1997;11:745–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Clinical Outcomes of Surgical Therapy (COST) Study Group. Fleshman JW, Nelson H,et al. Early results of laparoscopic surgery for colorectal cancer: retrospective analysis of 372 patients treated by Clinical Outcomes of Surgical Therapy (COST) Study Group. Dis Colon Rectum 1996;39(Suppl 10):S53–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Huscher C, Silecchia G, Croce Eet al. Laparoscopic colorectal resection. A multicenter Italian study. Surg Endosc 1996;10:875–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Köckerling F, Schneider C, Reymond MA,et al. Laparoscopic Colorectal Surgery Study Group (LCSSG). Early results of a prospective multicenter study on 500 consecutive cases of laparoscopic colorectal surgery. Surg Endosc 1998;12:37–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Lumley JW, Fielding GA, Rhodes M, Nathanson LK, Siu S, Stitz RW. Laparoscopic-assisted colorectal surgery: lessons learned from 240 consecutive patients. Dis Colon Rectum 1996;39:155–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Ortega AE, Beart RW Jr, Steele GD Jr, Winchester DP, Greene FL. Laparoscopic bowel surgery registry: preliminary results. Dis Colon Rectum 1995;38:681–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Schiedeck TH, Schwandner O, Bruch HP. Laparoscopic sigmoid resection in diverticulitis [in German]. Chirurg 1998;69:846–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Schwandner O, Schiedeck TH, Bruch HP. The role of conversion in laparoscopic colorectal surgery. Do predictive factors exist? Surg Endosc 1999;13:151–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Stitz RW, Lumley JW. Laparoscopic colorectal surgery—new advances and techniques. Ann Acad Med Singapore 1996;25:653–6.PubMedGoogle Scholar
  16. 16.
    Agachan F, Joo JS, Sher M, Weiss EG, Nogueras JJ, Wexner SD. Laparoscopic colorectal surgery. Do we get faster? Surg Endosc 1997;11:331–5.Google Scholar
  17. 17.
    Agachan F, Joo JS, Weiss EG, Wexner SD. Intraoperative laparoscopic complications: are we getting better? Dis Colon Rectum 1996;39(10 Suppl):14–9.CrossRefGoogle Scholar
  18. 18.
    Baca I, Schultz C, Gotzen V, Grzybowski L. Laparoscopy-assisted colorectal surgery. Early outcome in benign and malignant disease—a prospective study of 120 patients [in German]. Zentralbl Chir 1997;122:569–77.PubMedGoogle Scholar
  19. 19.
    Beart RW Jr. Laparoscopic colectomy: status of the art. Dis Colon Rectum 1994;37(Suppl):S47–9.PubMedGoogle Scholar
  20. 20.
    Bouillot JL, Aouad K, Badawy A, Alamowitch B, Alexandre JH. Elective laparoscopic-assisted colectomy for diverticular disease. A prospective study in 50 patients. Surg Endosc 1998;12:1393–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Bruce CJ, Coller JA, Murray JJ, Schoetz DJ Jr, Roberts PL, Rusin LC. Laparoscopic resection for diverticular disease. Dis Colon Rectum 1996;39(10 Suppl):S1–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Delgado Gomis F, Bolufer Cano JM, Grau Cardona E,et al. Early results of laparoscopic resection of colorectal cancer [in Spanish]. Rev Esp Enferm Dig 1998;90:323–34.PubMedGoogle Scholar
  23. 23.
    Eijsbouts QA, Cuesta MA, de Brauw LM, Sietses C. Elective laparoscopic-assisted sigmoid resection for diverticular disease. Surg Endosc 1997;11:750–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Falk PM, Beart RW Jr, Wexner SD,et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993;36:28–34.PubMedGoogle Scholar
  25. 25.
    Fine AP, Lanasa S, Gannon MP, Cline CW, James R. Laparoscopic colon surgery: report of a series. Am Surg 1995;61:412–6.PubMedGoogle Scholar
  26. 26.
    Franklin ME Jr, Rosenthal D, Abrego-Medina D,et al. Prospective comparison of open vs. laparoscopic colon surgery for carcinoma: five-year results. Dis Colon Rectum 1996;39(Suppl 10):S35–46.CrossRefPubMedGoogle Scholar
  27. 27.
    Hoffman GC, Baker JW, Fitchett CW, Vansant JH. Laparoscopic-assisted colectomy. Initial experience. Ann Surg 1994;219:732–43.PubMedGoogle Scholar
  28. 28.
    Hunkeler R, Gerst P, Seifert M, Wehrli H. Laparoscopic colon surgery in the regional hospital—initial experiences after 65 interventions [in German]. Schweiz Med Wochenschr 1997;Suppl 89:S25–30.Google Scholar
  29. 29.
    Jansen A. Laparoscopic-assisted colon resection. Evolution from an experimental technique to a standardized surgical procedure. Ann Chir Gynaecol 1994;83:86–91.PubMedGoogle Scholar
  30. 30.
    Köhler L, Rixen D, Troidl H. Laparoscopic colorectal resection for diverticulitis. Int J Colorectal Dis 1998;13:43–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Kwok SP, Lau WY, Carey PD, Kelly SB, Leung KL, Li AK. Prospective evaluation of laparoscopic-assisted large bowel excision for cancer. Ann Surg 1996;223:170–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Lacy AM, Garcia-Valdecasas JC, Delgado S,et al. Post-operative complications of laparoscopic-assisted colectomy. Surg Endosc 1997;11:119–22.CrossRefPubMedGoogle Scholar
  33. 33.
    Larach SW, Patankar SK, Ferrara A, Williamson PR, Perozo SE, Lord AS. Complications of laparoscopic colorectal surgery. Analysis and comparison of earlyvs. latter experience. Dis Colon Rectum 1997;40:592–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Lord SA, Larach SW, Ferrara A, Williamson PR, Lago CP, Lube MW. Laparoscopic resections for colorectal carcinoma: a three-year experience. Dis Colon Rectum 1996;39:148–54.CrossRefPubMedGoogle Scholar
  35. 35.
    Molenaar CB, Bijnen AB, de Ruiter P. Indications for laparoscopic colorectal surgery. Results from the Medical Centre Alkmaar, the Netherlands. Surg Endosc 1998;12:42–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Monson JR, Darzi A, Carey PD, Guillou PJ. Prospective evaluation of laparoscopic-assisted colectomy in an unselected group of patients. Lancet 1992;340:831–3.CrossRefPubMedGoogle Scholar
  37. 37.
    Phillips EH, Franklin M, Carroll BJ,et al. Laparoscopic colectomy. Ann Surg 1992;216:703–7.PubMedGoogle Scholar
  38. 38.
    Puente I, Sosa JL, Sleeman D, Desai U, Tranakas N, Hartmann R. Laparoscopic assisted colorectal surgery. J Laparoendosc Surg 1994;4:1–7.PubMedGoogle Scholar
  39. 39.
    Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT. Role of laparoscopy in colorectal surgery: a prospective evaluation of 200 cases. Dis Colon Rectum 1995;38:494–501.CrossRefPubMedGoogle Scholar
  40. 40.
    Reissman P, Cohen S, Weiss EG, Wexner SD. Laparoscopic colorectal surgery: ascending the learning curve. World J Surg 1996;20:277–82.CrossRefPubMedGoogle Scholar
  41. 41.
    Reissman P, Salky BA, Edye M, Wexner SD. Laparoscopic surgery in Crohn's disease. Indications and results. Surg Endosc 1996;10:1201–4.CrossRefPubMedGoogle Scholar
  42. 42.
    Reissman P, Salky BA, Pfeifer J, Edye M, Jagelman DG, Wexner SD. Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg 1996;171:47–51.CrossRefPubMedGoogle Scholar
  43. 43.
    Senagore AJ, Luchtefeld MA, Mackeigan JM. What is the learning curve for laparoscopic colectomy? Am Surg 1995;61:681–5.PubMedGoogle Scholar
  44. 44.
    Sher ME, Agachan F, Bortul M, Nogueras JJ, Weiss EG, Wexner SD. Laparoscopic surgery for diverticulitis. Surg Endosc 1997;11:264–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Slim K, Pezet D, Riff Y, Clark E, Chipponi J. High morbidity rate after converted laparoscopic colorectal surgery. Br J Surg 1995;82:1406–8.PubMedGoogle Scholar
  46. 46.
    Tucker JG, Ambroze WL, Orangio GR, Duncan TD, Mason EM, Lucas GW. Laparoscopically assisted bowel surgery. Analysis of 114 cases. Surg Endosc 1995;9:297–300.CrossRefPubMedGoogle Scholar
  47. 47.
    Wexner SD, Reissman P, Pfeifer J, Bernstein M, Geron N. Laparoscopic colorectal surgery: analysis of 140 cases. Surg Endosc 1996;10:133–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Wishner JD, Baker JW Jr, Hoffman GC,et al. Laparoscopic-assisted colectomy. The learning curve. Surg Endosc 1995;9:1179–83.CrossRefPubMedGoogle Scholar
  49. 49.
    Zucker KA, Pitcher DE, Martin DT, Ford RS. Laparoscopic-assisted colon resection. Surg Endosc 1994;8:12–8.PubMedGoogle Scholar
  50. 50.
    Köckerling F, Reymond MA, Schneider C,et al., Laparoscopic Colorectal Surgery Study Group. Prospective multicenter study of the quality of oncologic resections in patients undergoing laparoscopic colorectal surgery for cancer. Dis Colon Rectum 1998;41:963–70.CrossRefPubMedGoogle Scholar
  51. 51.
    Köckerling F, Schneider C, Reymond MA,et al. Laparoscopic Colorectal Surgery Study Group (LCSSG). Laparoscopic resection of sigmoid diverticulitis—results of a multicenter study. Surg Endosc 1999;13:567–71.CrossRefPubMedGoogle Scholar
  52. 52.
    Köckerling F, Rose J, Schneider C,et al. Laparoscopic Colorectal Surgery Study Group (LCSSG). Laparoscopic colorectal anastomosis—risk of postoperative leakage: results of a multicenter study. Surg Endosc 1999;13:639–644.CrossRefPubMedGoogle Scholar
  53. 53.
    Köckerling F, Reymond MA, Schneider C, Hohenberger W. Pitfalls and hazards in oncological laparoscopic surgery [in German]. Chirurg 1997;68:215–24.CrossRefPubMedGoogle Scholar
  54. 54.
    Begos DG, Arsenauld J, Ballantyne GH. Laparoscopic colon and rectal surgery at a VA hospital. Analysis of the first 50 cases. Surg Endosc 1996;10:1050–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Cagir B, Rangraj M, Maffuci L, Herz BL. The learning curve for laparoscopic cholecystectomy. J Laparoendosc Surg 1994;4:419–27.PubMedGoogle Scholar
  56. 56.
    Lekawa M, Shapiro SJ, Gordon LA, Rothbart J, Hiatt JR. The laparoscopic learning curve. Surg Laparosc Endosc 1995;5:455–8.PubMedGoogle Scholar
  57. 57.
    Sanabria JR, Gallinger S, Croxford R, Strasberg SM. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg 1994;179:696–704.PubMedGoogle Scholar
  58. 58.
    Liem MS, van Steensel CJ, Boelhouwer RU,et al. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. Am J Surg 1996;171:281–5.CrossRefPubMedGoogle Scholar
  59. 59.
    Rege RV, Joehl RJ. A learning curve for laparoscopic splenectomy at an academic institution. J Surg Res 1999;81:27–32.CrossRefPubMedGoogle Scholar
  60. 60.
    Watson DI, Baigrie RJ, Jamieson GG. A learning curve for laparoscopic fundoplication. Definable, avoidable, or waste of time? Ann Surg 1996; 224: 198–203.CrossRefPubMedGoogle Scholar
  61. 61.
    See WA, Cooper CS, Fisher RJ. Predictors of laparoscopic complications after formal training in laparoscopic surgery. JAMA 1993;270:2689–92.CrossRefPubMedGoogle Scholar
  62. 62.
    Sjödahl R, Nyström PO. Laparoscopic colorectal surgery in progress. Eur J Surg 1998;Suppl 582:S124–7.Google Scholar
  63. 63.
    Marusch F, Koch A, Kube R, Gastinger I. Laparoscopic creation of stomas—an ideal single indication in minimally invasive surgery [in German]. Chirurg 1999;70:785–8.CrossRefPubMedGoogle Scholar

Copyright information

© The American Society of Colon and Rectal Surgeons 2001

Authors and Affiliations

  • Frank Marusch
    • 1
  • Ingo Gastinger
    • 1
  • Claus Schneider
    • 1
  • Hubert Scheidbach
    • 1
  • Jochen Konradt
    • 1
  • Hans-Peter Bruch
    • 1
  • Lothar Köhler
    • 1
  • Eckhard Bärlehner
    • 1
  • Ferdinand Köckerling
    • 1
  • the Laparoscopic Colorectal Surgery Study Group (LCSSG)
  1. 1.Department of SurgeryCarl Thiem Hospital, Teaching Hospital of Humboldt UniversityCottbusGermany

Personalised recommendations