Predictive factors of conversion in laparoscopic colorectal surgery. Analysis from 1090 cases.

F Carballo, MD, M Laporte, MD, E Grzona, MD, A Canelas, MD, M Bun, MD, C Peczan, MD, N Rotholtz, MD

Colorectal Surgery Division – Hospital Aleman de Buenos Aires. Argentina.

Background: The laparoscopic approach for colorrectal disease has become a safe and reproducible method in the hands of trained surgeons. A proper selection criteria allows to decrease the rate of conversion, mainly in surgeons with less experience. The main objective of this study is to identify factors that favor conversion in a large series of laparoscopic colorectal procedures. The second objective is to evaluate if there any differences in outcome between the groups.

Methods: Retrospective study on a database prospectively made in 1090 patients who underwent laparoscopic colorectal surgery from June 2000 to June of 2012. They were considered as potential predictors of conversion: demographic factors; characteristics related to surgery and to the disease. univariate analysis to identify individual predictive factors was made. In the second instance all the analyzed values were included in logistic regression model for multivariate analysis.

Results: The series was divided in 2 groups: Patients operated on by laparoscopy (G2) and converted surgeries (G1). One hundred and one (9,2%) procedures required conversion. The main causes were: adhesions (26.7%); technical difficulties (12%); inflammatory processes; (13.8%) bleeding (10.89%); and others. Age 65 years (p< 0001), male gender (p< 0.003) and ASA III (p< 0.003) were demographic factors associated with conversion, whereas ASA I was identified as a protective factor (p < 0.003). Surgery for malignant disease was associated with conversion (p < 0.001), while those operated by polyps had lower incidence of this event (p< 0.002). Transit restitution (p< 0.002); low anterior resection (p< 0.006); complicated diverticulitis (p < 0.0003); intraoperative complications (p < 0.0001); and surgeries associated with other procedures (p< 0.0001) were identified as predictive factors of conversion. The unique variables that proved to be independent in the multivariate analysis were male gender (p< 0.0035); complicated diverticulitis (p< 0.0003); and intraoperative complications (p< 0.0001). G1 had a higher incidence of postoperative intensive care unit requirement (p< 0.001); incidence of reoperations (p< 0.02) and postoperative complications (p 0.001).

Conclusion: In a large series of laparoscopic colorectal resections male patients, complicated diverticulitis, and intraoperative complications are predictive factors of conversion. In turn, these patients have a higher chances for having postoperative complications.

Session: Poster Presentation

Program Number: P048

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