What influences conversion to open surgery during laparoscopic colorectal resection?

Introduction We analyzed the risk of morbidity and mortality in laparoscopic (Lap) conversion for colorectal surgery across a group of subspecialist surgeons with expertise in minimally invasive techniques. Methods We reviewed prospective data patients who underwent abdominopelvic procedures from 7/1/2007 to 12/31/2016 at a tertiary care facility. We identified procedures that were converted from Lap to open (Lap converted). Lap converted procedures were matched to Lap completed and open procedures based on elective versus urgent and surgeon. We also abstracted patient demographics and outcomes at 30 days using the American College of Surgeons National Surgical Quality Improvement Program defined adverse event list. We analyzed outcomes across these groups (Lap converted, Lap completed, open procedures) with x(2) and t tests and used the Bonferroni Correction to account for multiple statistical testing. Results From a database of 12,454 procedures, we identified 100 Lap converted procedures and matched them to 305 open procedures and 339 Lap completed procedures. In our dataset of abdominopelvic procedures, Lap techniques were attempted in 49 +/- 1%. We noted a higher risk of aggerate morbidity following open procedures (33 +/- 10) as compared to Lap converted (29 +/- 17%) and the matched Lap completed procedures (18 +/- 8%; p < 0.001). Converted cases had the longest operative time (222 +/- 102 min), compared to lap completed (177 +/- 110), and open procedures (183 +/- 89). There were no differences in mortality, sepsis complications, anastomotic leaks, or unplanned returns to the operating room across the three operative groups. Conclusions Although aggregate morbidity of Lap converted procedures is higher than in Lap completed procedures, it remains less than in matched open procedures. Compared to Lap completed procedures, the additional morbidity of Lap converted procedures appears to be related to additional surgical site infection risk. Our data suggest that surgeons should not necessarily be influenced by additional complications associated with conversion when contemplating complex laparoscopic colorectal procedures

Automated summary

The study found that patients who were converted to open surgery had a higher morbidity rate compared to those who underwent completed laparoscopic surgery. However, the overall morbidity rate of the converted procedures was still lower than open surgery. Importantly, the additional morbidity of converted procedures appears to be related to the risk of surgical site infection.