Potential considerations in decision making on laparoscopic colorectal resections in Hungary based on administrative data

Background Laparoscopic colorectal surgeries offer numerous advantages over their open counterparts. To compare these measurable short-time outcomes of open and laparoscopic resections in Hungary, data of colorectal surgeries were collected and analysed. The study focused on identifying patients’ characteristics that can influence the decision on laparoscopic colorectal resections and on comparing efficiency of Hungarian colorectal operations with international data. Methods Using patients’ data of laparoscopic and open colorectal surgery performed in 2015 and 2016 from the National Health Insurance Fund of Hungary, a countrywide retrospective comparative analysis was done. Logistic regression was used to explore main influencing factors for laparoscopic colorectal surgery. Results A total of 17,876 colorectal surgical cases, including 14,876 open and 3,000 laparoscopic resections were selected and analysed. Laparoscopy was used only in 16.78% of all cases. Comparison of age groups showed that odds ratio (OR) of laparoscopic colorectal resections was significantly lower in over 40 years than in younger patients (18–39 years). In university institutes patients had higher odds (OR: 2.23 p<0.0001) for laparoscopic colorectal resections. Presence of comorbidity codes and preoperative treatment in internal medicine department decreased odds for laparoscopic colorectal operations. Conclusions Patients’ age, comorbidities and hospital type influenced the likelihood of decision on laparoscopic colorectal resection. Selection of patients contributed to improved laparoscopic outcomes.

IS LAPAROSCOPIC REOPERATION FEASIBLE TO TREAT EARLY COMPLICATIONS AFTER LAPAROSCOPIC COLORECTAL RESECTIONS?

ABSTRACT Background: Recently, with the performance of minimally invasive procedures for the management of colorectal disorders, it was allowed to extend the indication of laparoscopy in handling various early and late postoperative complications. Aim: To present the experience with laparoscopic reoperations for early complications after laparoscopic colorectal resections. Methods: Patients undergoing laparoscopic colorectal resections with postoperative surgical complications were included and re-treated laparoscopically. Selection for laparoscopic approach were those cases with early diagnosis of complications, hemodynamic stability without significant abdominal distention and without clinical comorbidities that would preclude the procedure. Results: In four years, nine of 290 (3.1%) patients who underwent laparoscopic colorectal resections were re-approached laparoscopically. There were five men. The mean age was 40.67 years. Diagnoses of primary disease included adenocarcinoma (n=3), familial adenomatous polyposis (n=3), ulcerative colitis (n=1), colonic inertia (n=1) and chagasic megacolon (n=1). Initial procedures included four total proctocolectomy with ileal pouch anal anastomosis; three anterior resections; one completion of total colectomy; and one right hemicolectomy. Anastomotic dehiscence was the most common complication that resulted in reoperations (n=6). There was only one case of an unfavorable outcome, with death on the 40th day of the first approach, after consecutive complications. The remaining cases had favorable outcome. Conclusion: In selected cases, laparoscopic access may be a safe and minimally invasive approach for complications of colorectal resection. However, laparoscopic reoperation must be cautiously selected, considering the type of complication, patient’s clinical condition and experience of the surgical team.

Primary Outcome of Laparoscopic Colorectal Resections in a Northern Finnish Hospital: A Single Center Study

Background and Aims: Over the past decades, laparoscopic colorectal surgery has become widely used for various indications. Large multicenter studies have demonstrated that laparoscopy has clear advantages over open surgery. Compared to open procedures, laparoscopy decreases perioperative blood loss, post-operative pain, and hospitalization time, but provides equivalent long-term oncological and surgical results. Most studies have been conducted in high-volume institutions with selected patients, which may have influenced the reported outcome of laparoscopy. Here, we investigated the primary outcome of all laparoscopic colorectal resections performed between 2005 and 2015 in a low-volume center. Materials and Methods: This retrospective study included bowel resections performed between 2005 and 2015 in the Lapland Central Hospital. Data were retrieved from electronic patient registries, and all operations that began as a laparoscopy were included. Patient records were investigated to determine the primary surgical outcome and possible complications within the first 30 days after surgery. Results: During 2005–2015, 385 laparoscopic colorectal resections were performed. Indications included benign (n = 166 patients, 43.1%) and malignant lesions (n = 219 cases, 56.9%). The median patient age was 68 years, and 50.4% were male. The median American Society of Anesthesiologist score was III, and 48.5% of patients had an American Society of Anesthesiologist class of III or IV. The median hospital stay after surgery was 6 days (interquartile range: 3.8). The conversion rate to open surgery rate was 13%. The total surgical complication rate was 24.2%, and re-operation was required in 11.2% of patients. A total of 26 patients had anastomotic leakage, of which 16 required re-operations. The 30-day mortality was 0.8%. Conclusion: Our results showed that laparoscopic colorectal surgery in a peripheral hospital resulted in primary outcome rates within the range of those reported in previous multicenter trials. Therefore, the routine use of laparoscopic colorectal resections with high-quality outcome is feasible in small and peripheral surgical units.