Underlying cardiac disease is a major risk factor for abdominal surgery. While laparoscopic colorectal surgery is gaining widespread acceptance, the physiologic effects of a pneumoperitoneum coupled with extreme position changes and a potentially longer operation raise concern regarding the safety and efficacy of a minimally invasive approach in this patient cohort.
We examine all laparoscopic cases by a single surgeon to determine how the presence of cardiac comorbidities impacts the perioperative and postoperative course and compare these to a case-matched cohort of patients undergoing conventional open surgery.
Between September, 2005 and August, 2008, data relevant to 512 consecutive patients undergoing laparoscopic colorectal procedures by a single surgeon were prospectively entered into an IRB-approved laparoscopic database. Major cardiac comorbidities were present in 156 patients (30.5%). Diagnosis included colorectal neoplasia (N=59), diverticulitis (N=45), inflammatory bowel disease (N=24), volvulus (N=12), and other (N=16). There were no deaths. 4 cases (2.6%) were converted to open for adhesions (N=2), bleeding (N=1), and the presence of a large cancer (N=1). There were no untoward intraoperative cardiac or pulmonary events. The overall morbidity was 36% (N=56). Mean length of stay was 6.4 days (1-53).
Laparoscopic colorectal surgery is safe in patients with major cardiac comorbidities. The morbidity and mortality in patients undergoing major abdominal surgery is less in patients undergoing laparoscopic colorectal procedures compared to open surgery. In appropriately trained hands, a minimally invasive approach is associated with a decreased incidence of major perioperative morbidity and mortality in patients with underlying cardiac disease.
Program Number: P186