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Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center

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Abstract

Background

Laparoscopy has increasingly become the standard of care for patients who undergo colorectal surgery for both benign and malignant disease. On the basis of this growing experience, there is now an expanded role for laparoscopic approach to postoperative complications after primary colorectal resection. However, there is little literature specific to this topic. We report a ten-year experience with laparoscopic treatment of early complications following laparoscopic colorectal surgery.

Methods

From January 2003 to December 2012, a total of 1,292 patients underwent elective laparoscopic colorectal surgery in our department. One hundred and two (7.9 %) patients required reoperation for a postoperative complication. Laparoscopy has been also adopted as the preferred procedure for management of postoperative complications. A retrospective review of 84 patients who had relaparoscopy (RL) for postoperative complications, including peritonitis, ureteral injury, bowel obstruction, and bleeding, was performed.

Results

Reoperation was carried out laparoscopically in 79 (94.0 %) patients. Five (6.0 %) conversions were necessary because of massive colonic ischemia, generalized fecal peritonitis, and lack of working space. The most common finding at RL was anastomotic leakage (57.1 %) that was managed by peritoneal lavage and ileostomy in 91.7 % of cases. Six percent of patients had negative RL. Overall morbidity rate was 25.0 %. Five patients required additional surgery: four (5.1 %) after RL and one after a converted procedure. There were five (6.0 %) deaths from septic shock, myocardial infarction, and pulmonary embolism.

Conclusions

Laparoscopy is a safe and effective tool for management of complications following laparoscopic colorectal surgery. In this setting, RL represents the first step of re-exploration and treatment, with no delay to conversion to open procedure even in skilled laparoscopic hands.

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Disclosures

Drs. D. Cuccurullo, F. Pirozzi, A. Sciuto, U. Bracale, C. La Barbera, F. Galante, and Prof. F. Corcione have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli” – Monaldi Hospital, Via Leonardo Bianchi s.n.c., 80131, Naples, NA, Italy

    Diego Cuccurullo, Felice Pirozzi, Antonio Sciuto, Camillo La Barbera, Francesco Galante & Francesco Corcione

  2. Department of Surgical Specialities and Nephrology, University “Federico II” of Naples, Naples, Italy

    Umberto Bracale

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  1. Diego Cuccurullo
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  2. Felice Pirozzi
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  4. Umberto Bracale
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  6. Francesco Galante
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  7. Francesco Corcione
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Correspondence to Francesco Corcione.

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Cuccurullo, D., Pirozzi, F., Sciuto, A. et al. Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center. Surg Endosc 29, 1795–1803 (2015). https://doi.org/10.1007/s00464-014-3862-6

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  • DOI: https://doi.org/10.1007/s00464-014-3862-6

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