Abstract
Background
Reduction in length of stay has several advantages, including healthcare costs, patient choice, and minimizing hospital acquired infections. Additionally, length of stay is a surrogate marker of rate of recovery from the physiological insult of anaesthesia and surgery and complications thereof. A well-documented short-term benefit of laparoscopic compared to open colorectal resection is reduced length of stay.
Methods
This was a review of prospectively collected data on all laparoscopic colorectal resections performed in our unit. We analyzed patients having primary colorectal anastomosis, to assess the effect of conversion compared to completion laparoscopically. Furthermore we compared those with or without diverting stoma, for the effect of stoma formation on postoperative length of stay (LOS).
Results
Two hundred and thirteen patients had a colorectal resection. Of these 133 (62%) were left-sided or rectal resections. Resection with primary colorectal anastomosis was undertaken in 112 patients. A defunctioning stoma was performed in 13/112 (12%), and 32/112 (29%) were converted as the procedure could not be completed laparoscopically.
Conversion was not significantly associated with increased LOS with weighted median of 6.5 and 6 days for conversion and no conversion, respectively. However, stoma formation significantly increased LOS to a median of 10 days compared with a median of 6 days in patients without a stoma (p = 0.001, Mann–Whitney U).
Conclusions
The need for conversion, if performed in a timely and appropriate manner, has little impact on patient outcome compared to those completed laparoscopically, with no significant increase in LOS in our experience. In contrast, a diverting stoma does prolong LOS and some of the benefits of laparoscopic surgery may be lost unless patients requiring a stoma are identified preoperatively and have intensive pre- and postoperative stoma training.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schwenk W, Haase O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229
Clinical Outcomes of surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM; MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Pahlman L, Cuesta MA, Msika S, Morino M, Lacy AM; Colon Cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484
Casillas S, Delaney CP, Senagore AJ, Brady K, Fazio VW (2004) Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum 47:1680–1685
Gonzalez R, Smith CD, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2006) Consequences of conversion in laparoscopic colorectal surgery. Dis Colon Rectum 49:197–204
Belizon A, Sardinha CT, Sher ME (2006) Converted laparoscopic colectomy: what are the consequences? Surg Endosc 20:947–951
Karanjia ND, Corder AP, Bearn P, Heald RJ (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226
Law WI, Chu KW, Ho JW, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96
Chaudhri S, Brown L, Hassan I, Horgan AF (2005) Preoperative intensive, community-based versus traditional stoma education: a randomized, controlled trial. Dis Colon Rectum 48:504–509
Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (2006) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931
Folkesson J, Nilsson J, Pahlman L, Glimelius B, Gunnarsson U (2004) The circular stapling device as a risk factor for anastomotic leakage. Colorectal Dis 6:275–279
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cartmell, M.T., Jones, O.M., Moran, B. et al. A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection. Surg Endosc 22, 2643–2647 (2008). https://doi.org/10.1007/s00464-008-9776-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-9776-4