Skip to main content
SpringerLink
Log in

Consequences of Conversion in Laparoscopic Colorectal Surgery

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Introduction

Laparoscopic procedures converted to open approaches have been associated with higher complication rates than laparoscopic and open cholecystectomy and appendectomy. Laparoscopic colorectal resections have relatively high conversion rates compared with other laparoscopic procedures. This study was designed to evaluate outcomes of conversions compared with laparoscopic and open colorectal resections.

Methods

We reviewed 498 consecutive colorectal resections performed between 1995 and 2002. Procedures were divided into laparoscopic colorectal resections, open colorectal resections, or conversions. Demographics, underlying disease, type of procedure performed, and operative outcomes were compared between groups.

Results

Of the 238 laparoscopic procedures performed, 182 were completed laparoscopically and 56 (23 percent) required conversion; 260 were performed open. Conversions were associated with greater blood loss (200 (range, 50–750) vs. 100 (range, 30–900) ml), longer time to first bowel movement (82 (range, 40–504) vs. 72 (range, 12–420) hr), and longer length of stay (6 (range, 2–67) vs.. 5 (range, 2–62) days) than the laparoscopic colorectal resections group. There was no difference in operative time, transfusion requirements, intraoperative and postoperative complications, or mortality between conversions and laparoscopic colorectal resections. Conversions resulted in fewer patients requiring transfusions (4 vs. 14 percent), shorter time to first bowel movement (82 (range, 40–504) vs. 93 (range, 24–240) hr), and shorter length of stay (6 (range, 2–67) vs. 7 (range, 2–180) days) than in the open colorectal resections group. There were no differences in complications or mortality between the conversion group and the open colorectal resections group.

Conclusions

Laparoscopic colorectal resections has a relatively high conversion rate; however, the converted cases have outcomes similar to open colorectal resections. In fact, the converted group required fewer blood transfusions than the open group. Experience and good judgment are fundamental for timely conversion of a laparoscopic procedure to open to decrease complication rates. Despite a high conversion rate, surgeons should consider laparoscopic colorectal resections, because even when necessary, conversion does not result in poorer outcomes than laparoscopic colorectal resections or open colorectal resections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. U Hildebrandt K Kessler T Plusczyk et al. (2003) ArticleTitleComparison of surgical stress between laparoscopic and open colonic resections Surg Endosc 17 242–246 Occurrence Handle10.1007/s00464-001-9148-9 Occurrence Handle1:STN:280:DC%2BD3s%2Fms12ktA%3D%3D Occurrence Handle12399854

    Article  CAS  PubMed  Google Scholar 

  2. H Hasegawa Y Kabeshima M Watanabe et al. (2003) ArticleTitleRandomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer Surg Endosc 17 636–640 Occurrence Handle10.1007/s00464-002-8516-4 Occurrence Handle1:STN:280:DC%2BD3s7nvFGlsQ%3D%3D Occurrence Handle12574925

    Article  CAS  PubMed  Google Scholar 

  3. M Braga A Vignali L Gianotti et al. (2002) ArticleTitleLaparoscopic versus open colorectal surgery. A randomized trial on short-term outcome Ann Surg 236 759–767 Occurrence Handle10.1097/00000658-200212000-00008 Occurrence Handle12454514

    Article  PubMed  Google Scholar 

  4. AJ Senagore HJ Duepree CP Delaney S Dissanaike KM Brady VW Fazio (2002) ArticleTitleCost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences Dis Colon Rectum 45 485–490 Occurrence Handle10.1007/s10350-004-6225-x Occurrence Handle12006930

    Article  PubMed  Google Scholar 

  5. A Dwivedi F Chahin S Agrawal et al. (2002) ArticleTitleLaparoscopic colectomy vs. open colectomy for sigmoid diverticular disease Dis Colon Rectum 45 1309–1315 Occurrence Handle10.1007/s10350-004-6415-6 Occurrence Handle12394427

    Article  PubMed  Google Scholar 

  6. AM Lacy JC García-Valdecasas S Delgado et al. (2002) ArticleTitleLaparoscopy-assisted colectomy versus open colectomy for the treatment of non-metastatic colon cancer: a randomized trial Lancet 359 2224–2229 Occurrence Handle10.1016/S0140-6736(02)09290-5 Occurrence Handle12103285

    Article  PubMed  Google Scholar 

  7. CM Schlachta J Mamazza PA Seshadri MO Cadeddu R Fregoire EC Poulin (2001) ArticleTitleDefining a learning curve for laparoscopic colorectal resections Dis Colon Rectum 44 217–222 Occurrence Handle10.1007/BF02234296 Occurrence Handle1:STN:280:DC%2BD3M7ot1Sksg%3D%3D Occurrence Handle11227938

    Article  CAS  PubMed  Google Scholar 

  8. P Reissman S Cohen EG Weiss SD Wexner (1996) ArticleTitleLaparoscopic colorectal surgery: ascending the learning curve World J Surg 20 277–282 Occurrence Handle10.1007/s002689900044 Occurrence Handle1:STN:280:BymA38rmt1A%3D Occurrence Handle8661831

    Article  CAS  PubMed  Google Scholar 

  9. P Gervaz A Pikarsky M Utech et al. (2001) ArticleTitleConverted laparoscopic colorectal surgery. A meta-analysis Surg Endosc 15 827–832 Occurrence Handle10.1007/s004640080062 Occurrence Handle1:STN:280:DC%2BD3MrksFSitg%3D%3D Occurrence Handle11443444

    Article  CAS  PubMed  Google Scholar 

  10. C Chaisermartin ParticleDe Y Panis P Mognol P Valleur (2003) ArticleTitleSigmoïdectomie laparoscopique pour diverticulite: la phase d'apprentissage est-elle associée à une sur-morbidité? Ann Chir 128 81–87 Occurrence Handle10.1016/S0003-3944(02)00032-9

    Article  Google Scholar 

  11. C-M Lo S-T Fan C-L Liu et al. (1997) ArticleTitleEarly decision for conversion of laparoscopic to open cholecystectomy for treatment of acute cholecystitis Am J Surg 173 513–517 Occurrence Handle10.1016/S0002-9610(97)00005-6 Occurrence Handle1:STN:280:ByiA2M%2FnvV0%3D Occurrence Handle9207165

    Article  CAS  PubMed  Google Scholar 

  12. A Hellberg C Rudberg L Enochsson et al. (2001) ArticleTitleConversion from laparoscopic to open appendectomy: a possible drawback of the laparoscopic technique? Eur J Surg 167 209–213 Occurrence Handle1:STN:280:DC%2BD3Mvotlyquw%3D%3D Occurrence Handle11316407 Occurrence Handle10.1080/110241501750099438

    Article  CAS  PubMed  Google Scholar 

  13. JR Sanabria S Gallinger R Croxford SM Strasberg (1994) ArticleTitleRisk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy J Am Coll Surg 179 696–704 Occurrence Handle1:STN:280:ByqD2c%2FitFQ%3D Occurrence Handle7952482

    CAS  PubMed  Google Scholar 

  14. O Schwandner TH Schiedeck H-P Bruch (1999) ArticleTitleThe role of conversion in laparoscopic colorectal surgery. Do predictive factors exist? Surg Endosc 13 151–156 Occurrence Handle10.1007/s004649900927 Occurrence Handle1:STN:280:DyaK1M7hslCrsQ%3D%3D Occurrence Handle9918619

    Article  CAS  PubMed  Google Scholar 

  15. CM Schlachta J Mamazza PA Seshadri et al. (2000) ArticleTitleDeterminants of outcomes in laparoscopic colorectal surgery. A multiple regression analysis of 416 resections Surg Endosc 14 258–263 Occurrence Handle1:STN:280:DC%2BD3c3gtlCruw%3D%3D Occurrence Handle10741445 Occurrence Handle10.1007/s004640000050

    Article  CAS  PubMed  Google Scholar 

  16. CM Schmidt MA Talamini HS Kaurman et al. (2001) ArticleTitleLaparoscopic surgery for Crohn's disease: reasons for conversion Ann Surg 233 733–739 Occurrence Handle10.1097/00000658-200106000-00002 Occurrence Handle1:STN:280:DC%2BD3M3nslGltA%3D%3D Occurrence Handle11371731

    Article  CAS  PubMed  Google Scholar 

  17. F Marusch I Gastinger C Schneider et al. (2001) ArticleTitleImportance of conversion for results obtained with laparoscopic colorectal surgery Dis Colon Rectum 44 207–216 Occurrence Handle10.1007/BF02234294 Occurrence Handle1:STN:280:DC%2BD3M7ot1Sluw%3D%3D Occurrence Handle11227937

    Article  CAS  PubMed  Google Scholar 

  18. M-C Moine ParticleLe J-M Fabre C Vacher et al. (2003) ArticleTitleFactors and consequences of conversion in laparoscopic sigmoidectomy for diverticular disease Br J Surg 90 232–236 Occurrence Handle12555302 Occurrence Handle10.1002/bjs.4035

    Article  PubMed  Google Scholar 

  19. K Slim D Pezet Y Riff et al. (1995) ArticleTitleHigh morbidity rate after converted laparoscopic colorectal surgery Br J Surg 82 1406–1408 Occurrence Handle1:STN:280:BymD1Mjotl0%3D Occurrence Handle7489179

    CAS  PubMed  Google Scholar 

  20. A Tittel E Schippers M Anurov et al. (2001) ArticleTitleShorter postoperative agony after laparoscopic-assisted colonic resection? An animal study Surg Endosc 15 508–512 Occurrence Handle1:STN:280:DC%2BD3MzjtVCrsw%3D%3D Occurrence Handle11353971 Occurrence Handle10.1007/s004640000270

    Article  CAS  PubMed  Google Scholar 

  21. PH Tung CD Smith (1999) ArticleTitleLaparoscopic insufflation with room air causes exaggerated interleukin-6 response Surg Endosc 13 473–475 Occurrence Handle10.1007/s004649901015 Occurrence Handle1:STN:280:DyaK1M3ksVOmsg%3D%3D Occurrence Handle10227945

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emory Endosurgery Unit, Emory University School of Medicine, Atlanta, Georgia, USA

    Rodrigo Gonzalez M.D. & C. Daniel Smith M.D.

  2. Department of Surgery, Atlanta Medical Center, Atlanta, Georgia, USA

    Edward Mason M.D., Titus Duncan M.D., Russell Wilson M.D. & Jacqueline Miller M.D.

  3. Division of General Surgery, University of Missouri, Columbia, Missouri, USA

    Bruce J. Ramshaw M.D.

  4. MC44 McHaney Hall, One Hospital Drive, Columbia, Missouri, 65212, USA

    Bruce J. Ramshaw M.D.

Authors
  1. Rodrigo Gonzalez M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Daniel Smith M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edward Mason M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Titus Duncan M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Russell Wilson M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacqueline Miller M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bruce J. Ramshaw M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruce J. Ramshaw M.D..

About this article

Cite this article

Gonzalez, R., Smith, C.D., Mason, E. et al. Consequences of Conversion in Laparoscopic Colorectal Surgery. Dis Colon Rectum 49, 197–204 (2006). https://doi.org/10.1007/s10350-005-0258-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-005-0258-7

Key words

Search

Navigation