Laparoscopy has gained acceptance for the treatment of many colorectal disorders. However, the reality that laparoscopic cases are often time consuming and take longer than the conventional open approach has led to speculation that increased operative time may negatively affect the overall patient outcome.
We examine all laparoscopic cases performed by a single surgeon (N =512) in a prospectively maintained database to determine if increased operative time negatively impacts patient outcome with regards to EBL, length of stay, and overall morbidity and mortality.
Between September 2005 and August 2008, 96 patients (18.75%) underwent laparoscopic colorectal procedures with an operative time greater than or equal to 5 hours (300 – 623 minutes). The most common diagnosis were rectal cancer (N=29), ulcerative colitis (N=24), colon cancer (N=10), diverticulitis (N=9), familial adenomatous polyposis (N=7), Crohn’s disease (N=6), motility disorder (N=4), rectal prolapse (N=3), GI bleeding (N=1) and other (N=3). The mean EBL was 323 mL (10 – 1500) and no cases were converted to open. There were no mortalities. Overall morbidity was 31%; UTI/urinary retention (N=11), wound infection (N=7), ileus (N=6), leak (N=3), abscess (N=3), DVT (N=2), pneumonia, atelectasis, fistula, and post-op bleed (N=1 each). The average length of stay was 7.8 days (3 – 70) with 70% of patients discharged by POD 6.
Length of operation is not associated with adverse patient outcomes. In experienced hands, the potential need for a longer operative time should not deter the use of a laparoscopic approach as the benefits of minimally invasive surgery continue to show benefits over an open operation even when operative times exceed 5 hours.
Program Number: P178