A comparison of open vs laparoscopic emergency colonic surgery; short term results from a district

general hospital.D Vijayanand , A Haq, D Roberts, & S Anwar.

Department of Coloproctology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield. U.K.email: suhail.anwar@cht.nhs.uk

Elective laparoscopic surgery has become the treatment of choice for management of benign and malignant colonic disease. Minimal morbidity, less postoperative pain, faster recovery and shorter hospital stay has led to its expansion in colonic resections. The role of emergency laparoscopic surgery for colonic resections is not fully established yet.

Our aim was to compare the clinical outcomes of laparoscopic versus open emergency colonic resections performed in a district general hospital.

From October 2007 to June 2011, 32 patients were identified, who had an emergency bowel resection, performed by a single surgeon. The patients were divided into two groups: those with open resections (n=19) and those with laparoscopic approach (n=13). Overall there were 18 right sided resections, 8 subtotal colectomies and 6 Hartman’s procedures.

Data was collected retrospectively and the groups were compared with respect to indications for surgery, demographics, operative time, blood loss, perioperative morbidity and mortality and postoperative hospital stay. The statistical analysis was performed with the non-parametric test for independent samples and continuous variables; Fisher’s exact test was used for categorical values with p<0.05 considered significant.

There was no significant difference between the two groups with respect to age, gender, co-morbidities and type of resection performed. Median hospital stay was significantly shorter in the laparoscopic group (8 days versus 10 days; p-0.0437). Average operative time was longer in the laparoscopic group (239 ± 31 mins versus 149 ± 12 mins; p-0.0109). Thirty day mortality was 5% in the open and zero in the lap group. Complication rate was higher in the open vs. laparoscopic group (31% versus 7.6%): however this difference was not statistically significant. Two cases in laparoscopic group were converted to open due to tumour perforation in one and in another access was very limited due to grossly dilated bowel.

This is a non randomised comparison of laparoscopic vs. open emergency colonic surgery. Patients in the open group were from the earlier study period- our current practise is to laparoscope all emergencies. Emergency laparoscopic colectomies are feasible and safe with shorter length of stay. The laparoscopic procedure takes longer but shows a statistical trend toward lower morbidity.

INTRODUCTION RESULTS

METHODS

CONCLUSION

Indications for the Surgery Open (n) Laparoscopic (n)

Inflammatory Bowel Disease 31% (6) 54% (7)

Diverticular Perforation 11% (2) 8% (1)

Bowel Obstruction secondary to Tumour

42% (8) 23%(3)

Other 16% (3) 15% (2)

Table 1. Indications for surgery (p value 0.0542)

Open n=19

Laparoscopic n=13

p Value

Age, years (Mean ±SEM) 55 ± 6 41 ± 7 0.1343

Male / Female % 58/42 62/38 1.0000

ASA I II III

1126

0103

--

30 Day Mortality 1 0 --

Complications % (n) 31 (6) 8 (1) 0.1953

Reoperation 1 0 --

Readmission 1 0 --

Length of Stay, Median (Range) 10 (7-42) 8 (3-12) 0.0437

Table 2: Demographics and results in general