Mariano Laporte, MD, Maximiliano Bun, MD, Alejandro Canelas, MD, Esteban Grzona, MD, Carlos Peczan, MD, Nicolas Rotholtz, MD. Colorectal Unit, General Surgery Department, Hospital Aleman de Buenos Aires
PURPOSE: Anastomotic leakage (AL) is the most devastating complication in colorectal surgery. Laparoscopic reoperative surgery could maintain the benefits of the minimally invasive approach and should be an alternative in the management of AL.
METHODS: Data were prospectively collected from all patients undergoing laparoscopic colorectal surgery between July 2000 and July 2010. Patients who required laparoscopic reintervention because of AL (Group I, GI) were compared with the rest of the serie (Group II, GII). Data were statistically analyzed by using Student’s t-test and chi-squared test.
RESULTS: 860 laparoscopic colorectal procedures were included, 23 (2.67%) needed reoperative surgery because of AL. In 21 (91%) the laparoscopic approach was performed successfully. These patients were included in GI. The median time from first operation to reintervention was 4.7 days. Conversion rate was 19% (4 patients). In two cases a resection has to be made because of an isquemic descended colon. In the other two a great intestinal distention secondary to a generalized peritonitis didn´t allow an adequate abdominal cavity and motivated the conversion. In 16 (76%) the surgical tactic was profuse abdominal lavage, drainage and proximal ostomy. In only one patient the postoperative course wasn´t uneventful and needed a second exploration because development of a fecal peritonitis that required Hartmann’s surgery. Hospital stay was prolonged in G1 (G1: 10.5 ± 8 days vs. G2: 3.75 ± 3 days, p= 0,001 IC= 5.98-9.63) and postoperative complication rate was similar between GI and GII (G1: 5/21 vs. G2: 198/837; p=ns).
CONCLUSIONS: Laparoscopic reintervention can be easily performed to treat patients with AL. This technique does not increased postoperative complications compared with patients who had an uneventful postoperative course.
Program Number: P123