The British journal of surgery · 2007
Laparoscopic reintervention for anastomotic leakage after primary laparoscopic colorectal surgery.
СтатьяНазвание и аннотация: Перевод в очереди
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Wind J, Koopman A G, van Berge Henegouwen M I, Slors J F M, Gouma D J, Bemelman W A
Аннотация
BACKGROUND: Anastomotic leakage is associated with high morbidity and mortality rates. The aim of this study was to assess the potential benefits of a laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery.
METHODS: Between January 2003 and January 2006, ten patients who had laparoscopic colorectal resection and later developed anastomotic leakage had a laparoscopic reintervention. A second group included 15 patients who had relaparotomy after primary open surgery.
RESULTS: Patient characteristics were comparable in the two groups. The median time from first operation to reintervention was 6 days in both groups. There were no conversions. The intensive care stay was shorter in the laparoscopic group (1 versus 3 days; P = 0.002). Resumption of a normal diet (median 3 versus 6 days; P = 0.031) and first stoma output (2 versus 3 days; P = 0.041) occurred earlier in the laparoscopic group. The postoperative 30-day morbidity rate was lower (four of ten patients versus 12 of 15; P = 0.087) and hospital stay was shorter (median 9 versus 13 days; P = 0.058) in the laparoscopic group. No patient developed incisional hernia in the laparoscopic group compared with five of 15 in the open group (P = 0.061).
CONCLUSION: These data suggest that laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery is associated with less morbidity, faster recovery and fewer abdominal wall complications than relaparotomy.
METHODS: Between January 2003 and January 2006, ten patients who had laparoscopic colorectal resection and later developed anastomotic leakage had a laparoscopic reintervention. A second group included 15 patients who had relaparotomy after primary open surgery.
RESULTS: Patient characteristics were comparable in the two groups. The median time from first operation to reintervention was 6 days in both groups. There were no conversions. The intensive care stay was shorter in the laparoscopic group (1 versus 3 days; P = 0.002). Resumption of a normal diet (median 3 versus 6 days; P = 0.031) and first stoma output (2 versus 3 days; P = 0.041) occurred earlier in the laparoscopic group. The postoperative 30-day morbidity rate was lower (four of ten patients versus 12 of 15; P = 0.087) and hospital stay was shorter (median 9 versus 13 days; P = 0.058) in the laparoscopic group. No patient developed incisional hernia in the laparoscopic group compared with five of 15 in the open group (P = 0.061).
CONCLUSION: These data suggest that laparoscopic reintervention for anastomotic leakage after primary laparoscopic surgery is associated with less morbidity, faster recovery and fewer abdominal wall complications than relaparotomy.