Shashank Sharma, MD1, Deborah S Keller, MS, MD2,3, Jessica Hyejin Oh, BS4, Alison R Althans, BS4, Emre Gorgan, MD1, Scott R Steele, MD1. 1Cleveland Clinic Foundation, 2Columbia University Medical Center, 3University College London Hospitals, NHS Foundation Trusts, 4Case Western Reserve University School of Medicine
Background: Minimally invasive surgery (MIS) has proven benefits over open colorectal surgery, including a lower incidence of postoperative complications. Even with MIS, postoperative ileus and small bowel obstructions (POI/SBO) remain a common and costly complication. Thus, efforts to address and decrease the incidence are warranted. Little evaluation has been performed on their rates across different MIS approaches. Our goal was to evaluate the incidence and associated factors for POI/ SBO across laparoscopic and robotic approaches.
Methods: Review of a prospectively-maintained departmental database for elective colorectal resectional cases performed at a major tertiary referral center from 2010-2016 was performed. Eligible patients who had minimally invasive surgery were stratified in multiport laparoscopic and robotic cohorts, and included if they had POI/SBO after surgery. Comparative analysis assessed the demographic, perioperative, and postoperative outcomes. The main outcome measures were the incidence rate, associated variables, and time to ileus/ SBO across the MIS platforms.
Results: During the study period 4161 total patients were reviewed- 3856 laparoscopic and 305 robotic. Postoperatively, 512 (13.28%) laparoscopic and 49 (16.07%) robotic patients suffered from POI/SBO. Within this cohort, there were no significant differences in age, gender, BMI, or comorbidity across approaches. More robotic patients had prior abdominal operations (p<0.05). The main indication for operation differed across the laparoscopic and robotic groups- inflammatory bowel disease and colorectal cancer, respectively (p<0.05). The main procedure performed was a segmental resection in the laparoscopic and an LAR in the robotic group (p<0.05). In both groups, extensive lysis of adhesions, midline extraction, and extracorporeal anastomosis were associated with development of POI/ SBO. With POI/SBO, the index length of stay (LOS) was longer in the laparoscopic cohort (6.42 vs. 5.72 days, p<0.05). The laparoscopic group also had significantly more 30-day readmissions (10.74% vs. 4.08%), a higher reoperation rate (19.14% vs. 8.16%), and longer LOS for the readmission episode than the robotic group (4.24 vs. 1.50 days) (all p<0.05). Laparoscopic SBO occur significantly later after the index procedure than robotic SBO (24.67 vs. 6.01 months, p<0.05).
Conclusions: The rate of POI/ SBO is considerable and comparable across laparoscopic and robotic approaches. However, there are distinct differences in the severity, time to occurrence, and impact on quality measures, such as LOS and readmissions between laparoscopic and robotics. This information could be an important factor in which approach the surgeon choses, as well as affecting the value proposition of the different technologies in colorectal surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86976
Program Number: P744
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster