Does Laparoscopic Fecal Diversion Offer Better Outcomes? A Comparative Study of 196 Consecutive Patients ?

Emre Gorgun, Fazli C Gezen, Erman Aytac, Luca Stocchi, Meagan M Costedio, Feza Remzi. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio.

INTRODUCTION: Laparoscopic fecal diversion in patients with complicated colon and rectal conditions is frequently performed. We aim to compare operative and short-term postoperative outcomes between laparoscopic and open fecal diversion.

METHODS AND PROCEDURES: Patients undergoing laparoscopic or open fecal diversion between February 2010 and September 2012 were included in the study. Patients who were given a diversion stoma to protect the distal intestinal anastomosis were excluded. Patient characteristics, operative results and postoperative outcomes were compared between the laparoscopic and open groups.

RESULTS: 196 consecutive patients underwent laparoscopic (n=63) versus open (n=133) fecal diversion during the study period. BMI was higher in the laparoscopy group (27vs.25 kg/m2;p=0.04) with comparable ASA scores (3vs.3;p=0.33). Laparoscopy was associated with shorter hospital stay (6vs.11 days;p<0.001), lower rate of postoperative ileus (5 vs.17 %; p=0.03), and less re-admissions (3vs.16 %;p=0.02). While operating times (67vs.72 min; p=0.16) were similar, estimated blood loss (82vs.32 ml;p=0.0004) was lower in the laparoscopy group. Conversion rate was 1.6% in the laparoscopy group. Only one laparoscopic case (1.6%) was converted to open surgery. Stoma complications including high stoma output (2 in the open group, 1 in the laparoscopic), retraction (2 in the open group, 1 in the laparoscopic), peristomal dermatitis (1 in the laparoscopic group) and stricture (1 in the open group) were similar between the groups (p>0.05). Postoperative mortality was comparable between the groups (2vs.1%;p=0.54).

CONCLUSIONS: Laparoscopic stoma creation for complex colorectal conditions provides significantly shorter hospital stay, less ileus and decreased rate of hospital re-admission compared to open surgery. Furthermore, use of this approach may decrease morbidity and subsequently reduce hospital costs in carefully selected patients.