What is the definition of “conversion” in laparoscopic surgery among colorectal surgeons? a survey among SAGES and ASCRS

Background: Various definitions are used in the literature to define conversion, rendering comparison among studies difficult. A web-based and postal survey was conducted among colorectal surgeons representing the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the American Society of Colon and Rectal Surgeons (ASCRS) regarding their definition of conversion during laparoscopic colorectal surgery and, consequently, determine the most commonly used definition. Materials and Methods: The multiple choice questionnaire included 3 parts: surgeon information (type, volume and time period of practice), various definitions for conversion, and 4 clinical scenarios. Surgeons were asked to check the definition(s) they considered best described conversion. Results: 25% responded out of 1000 surgeons; approximately half have a private based practice. 53% have more than 10 years experience while 35% have 5-10 years. 35.9% perform more than 50 cases of laparoscopic colon surgery per year; however, only 12% perform more than 25 laparoscopic rectal cases per year and 60% perform less than 10. 68.4% agreed that any incision made earlier than initially planned to complete the procedure should be considered as conversion. 81.4% felt that an incision >5 cm is not considered a conversion; 53.4% considered an incision >10cm a conversion while 37% did not. Neither extracorporeal vessel ligation (73.8%), bowel resection (81.2%), anastomosis (77%), nor incision made for specimen retrieval (91.1%) was counted as conversion. Regarding clinical case scenarios, 62% regarded an incision made to facilitate phlegmon dissection after laparoscopically mobilizing the left colon up to and around the splenic flexure to be laparoscopic-assisted. 55.6% considered a 10cm incision required for fistula take-down after completion of laparoscopic dissection as conversion. A 10 cm incision made for the rectal dissection in rectopexy and anastomosis was described as conversion in 51% but laparoscopic-assisted in 49%. Increasing a 5cm incision to 12cm for specimen extraction was considered laparoscopic-assisted in 49.3%. Conclusion: The majority of surgeons clearly consider any incision made earlier than planned as a conversion, but not extracorporeal vessel ligation or bowel resection-anastomosis. However, there are still conflicting views of conversion regarding incision length and some clinical situations, which may influence published and presented outcomes among various centers. Definitions of conversion used in practice are much more liberal than published definitions, thus explaining the low conversion rates.

Session: Podium Presentation

Program Number: S100

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