Esteban Grzona, MD, F Carballo, MD, M Bun, MD, A Canelas, MD, M Laporte, MD, L Pereyra, MD, C Peczan, MD, N Rotholtz, MD
Colorectal Surgery Division – Hospital Aleman de Buenos Aires. Argentina.
Postoperative ileus predictive factors after laparoscopic colorectal surgery.
Background: Post-operative ileus (PI) is defined as a transitory disorder of gastrointestinal motility caused by surgery. The pathogenesis is multifactorial and complex. Postoperative ileus generates a delayed discharge. While one of the benefits of laparoscopy is to shorten the recovery time when the ileus occurs in these cases, this benefit is lost. It would be very useful to identify factors that predispose the development of ileus in patients undergoing laparoscopic colorectal surgery
Objective: The main objective of this study is to evaluate the incidence of PI in laparoscopic colorectal surgery and to identify predictive factors.
Methods: A retrospective analysis based on a prospective database was performed on all patients operated between June 2000 and June 2011. All the colorectal resections were included. PI was defined as the condition that delays the post-operative recovery time and intestinal transit without a secondary etiology. Demographic data; surgery causes; type of the procedure; and morbidity with special relation to the bowel function were assessed. Predictive factors were evaluated by comparing patients with normal recovery (G1) and patients with PI (G2). The results were expressed as odds ratio (OR) and their 95% confidence intervals (CI). The factors were considered significant at p<0.05 or an OR which does not cross the unit.
Results: A total of 869 patients were evaluated. 23 patients were excluded due to secondary ileus. Median age was 58.7(15-92) years and 55.1% were men. Fifty one (6%) patients had PI (G2). The mean length of stay of the whole series was ## +/- days. G1 had a mean length of stay significantly shorter than G2 [G1vs G2: 3.9(2-8) vs. 9.4 (3-20) days (p <0.05)]. There were no demographic differences between the groups. Recovery parameters of bowel function were significantly shorter in G1 [bowel sounds (+): 0.85 vs. 1.4, (p <0.05); flatus 1.5 vs 2.8 days (p <0.05); liquids intake 1.1 vs. 5.9 days, (p <0.05); solid intake 2.1 vs. 7.2 (p <0.05) days]. The following parameters were significant in the univariate analysis: Surgical time >180 min [G1vs G2: 308/795(38.7%) vs 28/51(54.9%) OR 1.85 (CI: 1.05-3.25, p <0.05)]; conversion rate [G1vs G2: 73/795 (9.1%) vs 14/51 (27.45%) OR: 10.95 (CI 5.24-16.66, p <0.01)]; left colectomy [G1vs G2: 386/795(48.5%)vs 13/51 (25.5%) OR (-5.24) (CI: (-1.87) – (-8.61), p <0.01)]; and total colectomy [G1vs G2: 20/795 (2.5%) vs 5/51 (9.8%), OR: 14.4 (CI :3.33-25 .47, p <0.05)]. When multivariate analysis was performed, predictive factor for PI were total colectomy OR: 13.5 (CI: 2.18-10.47) and conversion OR: 3.84 (CI: 1.84-8.04), while left colectomy showed as a protector of PI, OR: 0.37 (CI: 0.18 to 0.75).
Conclusion: Total colectomy and conversion are predictive factors of postoperative ileus, while left colectomy is an independent protective factor. Although the design of this study fail to achieve significant conclusions, it shows that there are patients operated by laparoscopic colonic resections evolving with postoperative ileus and could be prevented by identifying those risk factors.
Session: Poster Presentation
Program Number: P051
