Abstract
PURPOSE: The aim of this study was to assess various intraoperative and postoperative complications associated with laparoscopic colorectal surgery. Specifically, the impact of surgical experience and procedure type on complications was analyzed. METHODS: All patients who underwent laparoscopic surgery were analyzed by age, sex, surgical indications, procedure performed, procedure length, intraoperative and postoperative complications, incidence and causes for conversion, duration of postoperative ileus, and length of hospital stay. Patients were classified for type of procedure and chronologically into four consecutive groups. Procedures were also categorized into four different groups: GI, total abdominal colectomies; GII, segmental resections; GIII, diverting procedures; GIV, others (abdominoperineal resection, Hartmann's creation or closure, anterior resection, and rectopexy). RESULTS: Between August 1991 and October 1995, 167 patients of a mean age of 49.6 (15–88) years underwent laparoscopic colorectal procedures. All procedures were electively performed. Common indications for surgery included inflammatory disease in 70 (42 percent), neoplasia in 56 (33 percent), functional bowel disorders in 30 (18 percent), and other forms of colorectal disorders in 11 (7 percent) patients. The most significant variable affecting intraoperative laparoscopic complication rate was surgical experience measured as the time interval during which surgery was performed (P =0.02). Total complication rate decreased from 29 percent during the first period to 11 percent by the second period (P <0.04) and 7 percent during the third period (P <0.005). Thus, the learning curve appeared to have required more than 50 cases to achieve. Moreover, even after performance of 94 (1991–1993) procedures in GI and GIV, these procedures were associated with higher complication rates than were those procedures in GII and GIII (P =0.04). CONCLUSION: Surgical experience and case selection are the most critical variables by which the surgeon can decrease the intraoperative laparoscopic complication rate.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
See WA, Cooper CS, Fisher RJ. Predictors of laparoscopic complications after formal training in laparoscopic surgery. JAMA 1993;270:2689–92.
Ramos R. Complications in laparoscopic colon surgery: prevention and management. Semin Colon Rectal Surg 1994;5:239–43.
Berci G. Complications of laparoscopic surgery. Surg Endosc 1994;8:165–6.
Guillou PJ, Darzi A, Monson JR. Experience with laparoscopic colorectal surgery for malignant disease. Surg Oncol 1993;2(Suppl 1):43–9.
Falk PM, Beart RW Jr, Wexner SD,et al. Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 1993;36:28–34.
Clavien P-A, Sanabria JR, Mentha G,et al. Recent results of elective open cholecystectomy in a North American and a European Center. Ann Surg 1992;216:618–26.
Fowler DL, White SA. Laparoscopy-assisted sigmoid resection. Surg Laparosc Endosc 1993;3:115–8.
Larach SW, Salomen MC, Williamson PR, Goldstein E. Laparoscopic assisted abdominoperineal resection. Surg Laparosc Endosc 1993;3:115–8.
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.
Nogueras J, Wexner SD. Laparoscopic colon resection. Perspect Colon Rectal Surg 1992;5:79–97.
Balantyne GH. Laparoscopically assisted anterior resection for rectal prolapse. Surg Laparosc Endosc 1992;2:230–6.
Wexner SD, Johansen OB. Laparoscopic bowel resection: advantages and limitations. Ann Med 1992;24:105–10.
Monson JR, Hill AD, Darzi A. Laparoscopic colonic surgery. Br J Surg 1995;82:150–7.
Puente I, Sosa JL, Sleeman D, Desai U, Tranakas N, Hartmann R. Laparoscopic-assisted bowel surgery. J Laparoendosc Surg 1994;4:1–7.
Sosa JL, Sleeman D, Puente I, McKenney MG, Hartmann R. Laparoscopic-assisted colostomy closure after Hartmann's procedure. Dis Colon Rectum 1994;37:149–52.
Peters WR, Bartels TL. Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 1993;36:751–6.
Schrenk P, Woisetschlager R, Wayand WU. Laparoscopic cholecystectomy: cause of conversions in 1300 patients and analysis of risk factors. Surg Endosc 1995;9:25–8.
Scott TR, Zucker KA, Bailey RW. Laparoscopic cholecystectomy: a review of 12397 patients. Surg Laparosc Endosc 1992;2:191–8.
Fowler DL, White SA, Anderson CA. Laparoscopic colon resection: 60 cases. Surg Laparosc Endosc 1995;6:468–71.
Weiss EG, Wexner SD. Training and preparing for laparoscopic colectomy. Semin Colon Rectal Surg 1994;4:224–7.
Senagore AJ, Luchtefeld MA, Mackergan JM. What is the learning curve for laparoscopic colectomy? Am Surg 1995;61:681–5.
Agachan F, Gilliland R, Joo JS, Sher ME, Wexner SD. The impact of experience on the outcome of laparoscopic colorectal surgery over four years [abstract]. Surg Endosc 1996;10:219.
Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic total abdominal colectomy: a prospective trial. Dis Colon Rectum 1992;35:651–5.
Author information
Authors and Affiliations
Additional information
Supported in part by the David G. Jagelman M.D. Memorial Research and Education Fund.
Read at the meeting of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.
About this article
Cite this article
Agachan, F., Joo, J.S., Weiss, E.G. et al. Intraoperative laparoscopic complications. Dis Colon Rectum 39 (Suppl 10), S14–S19 (1996). https://doi.org/10.1007/BF02053800
Issue Date:
DOI: https://doi.org/10.1007/BF02053800