Emergency laparoscopic colectomy: does it measure up to open?

doi:10.1016/j.amjsurg.2008.09.010

The American Journal of Surgery

Volume 197, Issue 3, March 2009, Pages 296-301

https://doi.org/10.1016/j.amjsurg.2008.09.010 Get rights and content

Abstract

Background

Laparoscopic colectomy has become the standard of care for elective resections; however, there are few data regarding laparoscopy in the emergency setting.

Methods

By using a database with prospectively collected data, we identified 94 patients who underwent an emergency colectomy between August 2005 and July 2008. Laparoscopic surgeries were performed in 42 patients and were compared with 25 patients who were suitable for laparoscopy but received open colectomy.

Results

The groups had similar demographics with no differences in age, sex, or surgical indications. Blood loss was lower (118 vs 205 mL; P < 0.01) and the postoperative stay was shorter (8 vs 11 d; P = 0.02) in the laparoscopic patients, and perioperative mortality rates were similar between the 2 groups (1 vs 3; P = 0.29).

Conclusions

With increasing experience, laparoscopic colectomy is a feasible option in certain emergency situations and is associated with shorter hospital stay, less morbidity, and similar mortality to that of open surgery.

Section snippets

Materials and Methods

By using an institutional review board–approved, prospectively collected patient database, we identified 94 patients who underwent emergency colectomy between August 2005 and July 2008. Additional patient demographics, indications for surgery, surgical details, and postoperative complications were collected retrospectively via chart review after approval by the University Hospitals of Cleveland's Institutional Review Board. Laparoscopic emergency colectomies were performed in 42 consecutive

Results

Ninety-four emergency colectomy cases were identified. Fifty-two patients underwent open emergency colectomies and 42 patients received laparoscopic emergency colectomies. Twenty-seven patients were excluded from the open group (Fig. 1) because of earlier-mentioned criteria. Two patients were excluded from the laparoscopic group because of a primary hand-assisted approach. Twenty (80%) of the open cases and 32 (80%) of the laparoscopic cases were emergent. There were 4 conversions in the

Conclusions

Few studies address the feasibility of laparoscopic colectomy in the emergency setting. In a case-control study comparing laparoscopic total colectomy for acute colitis with a matched open colectomy group, Marcello et al¹⁰ found that laparoscopic total colectomy was feasible and led to a faster recovery. Ng et al⁹ used 7 consecutive patients to study the role of emergency laparoscopically assisted right hemicolectomy for obstructing right-sided colon carcinoma, and found that this approach

Acknowledgments

This study was supported, in part, by grant T32 HS00059 from the Agency for Healthcare Research and Quality. In addition, Ethicon Endo-Surgery, Inc. provided unrestricted research funds that went towards salary support for J.J.S.

References (12)

A.M. Lacy et al.
Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial
Lancet
(2002)
P.J. Guillou et al.
Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial
Lancet
(2005)
M.R. Marohn et al.
Laparoscopic total abdominal colectomy in the acute setting
J Gastrointest Surg
(2005)
A comparison of laparoscopically assisted and open colectomy for colon cancer
N Engl J Med
(2004)
K.A. Garrett et al.
A single training center's experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically?
Surg Endosc
(2008)
S.W. Lee et al.
Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis
Dis Colon Rectum
(2006)

There are more references available in the full text version of this article.

Cited by (29)

Urgent Inpatient Colectomy Carries a Higher Morbidity and Mortality than Elective Surgery
2021, Journal of Surgical Research
Citation Excerpt :
While the use of laparoscopy in colorectal surgery has increased significantly, its use in urgent and emergent colorectal resection remains low.14,18 Several studies have evaluated the use of laparoscopy for urgent and emergency colorectal resections, and found it to be feasible, or even superior to open colectomy in regards to short-term complications.18,19,20 Offering minimally invasive surgery, whenever feasible, to patients undergoing urgent and emergency colorectal surgery may help reduce post-operative morbidity.
Emergency colorectal surgery confers a higher risk of adverse outcomes compared to elective surgery. Few studies have examined the outcomes after urgent colectomies, typically defined as those performed at the index admission, but not performed at admission in an emergency fashion. The aim of this study is to evaluate the risk of adverse outcomes following urgent inpatient colorectal surgery.
All adult patients undergoing colectomy between 2013 and 2017 in the ACS NSQIP were included in the analysis. Patients were grouped into Elective, Urgent and Emergency groups. The Urgent group was further stratified by time from admission to surgery. Baseline characteristics and 30 day outcomes were compared between the Elective, Urgent and Emergency groups using univariable and multivariable analyses.
104,486 patients underwent elective colorectal resection. 23,179 underwent urgent while 22,241 had emergency resections. Patients undergoing urgent colectomy presented with increased comorbidities, and experienced higher mortality (2.5-4.1%, AOR 2.3 (1.9 – 2.8)) compared to elective surgery (0.4%). Urgent colectomy was an independent risk factor for the majority of short term complications documented in NSQIP. Moreover, patients undergoing urgent colectomy more than a week following admission had an increased risk of bleeding, deep venous thrombosis, pulmonary embolism, urinary tract infection, and prolonged hospitalization.
Urgent colectomies are associated with a greater risk of adverse outcomes compared to elective surgery. Urgent status is an independent risk factor for post operative mortality and morbidity. Further characterization of this patient population and their specific challenges may help ameliorate these adverse events.
Comparative analysis of outcomes after multiport and single-port laparoscopic colectomy in emergency situations: Is single-port laparoscopic colectomy safe and feasible?
2018, Asian Journal of Surgery
Citation Excerpt :
In our study, emergency colectomy included both emergent and urgent colectomies. The procedure was considered emergent if a patient was scheduled for surgery immediately after evaluation by the staff surgeon, and the procedure was booked as an emergency mandating that the operating room staff have a team available as soon as possible.15,16 The procedure was considered urgent if a patient was unable to be discharged because of their deteriorating condition and then underwent surgery.
Although consensus has been reached on the superiority of laparoscopy for a majority of conditions underlying acute abdominal pain, the safety and feasibility of single-port laparoscopic colectomy (SPLC) in emergency situations have not been determined.
A prospective electronic database of all emergency patients who underwent either multiport laparoscopic colectomy (MPLC) or SPLC between April 2006 and December 2014 was used to compare the surgical outcomes of these operative methods.
During the study period, 31 MPLCs and 76 SPLCs were performed. These two operative methods resulted in similar operating times, transfusion amounts, lengths of stay, postoperative complications, attainment of lymph nodes, and proximal and distal cut margins. However, the SPLC group had a shorter time to first flatus (2.8 ± 1.9 days vs. 3.8 ± 1.5 days, p = 0.005), earlier reinitiation of free oral fluids (3.2 ± 2.1 days vs. 4.4 ± 1.8 days, p = 0.002), and lesser requirement of narcotic analgesics (2.5 ± 3.9 times vs. 4.7 ± 4.8 times, p = 0.017).
SPLC could be a safe and effective alternative to MPLC, even in emergency situations when performed by surgeons who have overcome the learning curve associated with single-port laparoscopic techniques. The tendency toward earlier returns to bowel function and decreased incidence of postoperative analgesic use would be potential benefits of SPLC in emergency situations.
Laparoscopic versus open colectomy for obstructing right colon cancer: A systematic review and meta-analysis
2017, Journal of Visceral Surgery
Citation Excerpt :
After 34 duplicate excluded, the successfully screening titles and abstracts for relevance and assessment for eligibility, 41 articles were excluded; successively 8 full text were excluded leaving 5 studies for analysis in the present review. The characteristics of the studies analysed are shown in Table 1 [20,21,23,24,29]. All the reports were published between 2008 and 2015.
Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer.
A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108).
Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques.
The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting.
LapEmerge-trial: laparoscopic approach for emergent colon resection; a multicentre, open label, randomized controlled trial.
2023, Research Square
Emergency Left Colectomy for Colon Cancer is Not Associated with Worst Oncologic Resection Quality Compared to Elective Surgery
2023, Research Square
Minimally Invasive Surgery is Associated with Improved Outcomes Following Urgent Inpatient Colectomy
2022, Journal of the Society of Laparoendoscopic Surgeons

View all citing articles on Scopus

View full text

The Midwest Surgical AssociationEmergency laparoscopic colectomy: does it measure up to open?

Abstract

Background

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Conclusions

Acknowledgments

Lancet

Lancet

J Gastrointest Surg

A comparison of laparoscopically assisted and open colectomy for colon cancer

N Engl J Med

A single training center's experience with 200 consecutive cases of diverticulitis: can all patients be approached laparoscopically?

Surg Endosc

Laparoscopic vs. hand-assisted laparoscopic sigmoidectomy for diverticulitis

Dis Colon Rectum

The Midwest Surgical Association
Emergency laparoscopic colectomy: does it measure up to open?