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Missed Opportunity: Laparoscopic Colorectal Resection Is Associated With Lower Incidence of Small Bowel Obstruction Compared to an Open Approach.
- Source :
-
Annals of surgery [Ann Surg] 2016 Jul; Vol. 264 (1), pp. 127-34. - Publication Year :
- 2016
-
Abstract
- Objective: To investigate the effect of a laparoscopic approach on the rate of adhesion-related small bowel obstruction (SBO) following colorectal resection.<br />Background: Currently, there is little compelling evidence with regard to rates of SBO after laparoscopic versus open abdominal surgery. Few studies have compared risk-adjusted rates of SBO following laparoscopic and open colorectal resection.<br />Methods: The Statewide Planning and Research Cooperative System was queried for elective colorectal resections in New York State from 2003 to 2010. A propensity score was calculated to account for selection bias between choice of laparoscopic versus open resection. Bivariate and multivariable competing-risks models were constructed to assess patient, hospital, surgeon, and operative characteristics associated with SBO and operation for SBO within 3 years of resection.<br />Results: Among 69,303 patients who underwent elective colorectal resection (26% laparoscopic, 74% open), 5.3% of patients developed SBO and 2% of patients underwent an operation for SBO. After controlling for other risk factors and conducting an intention-to-treat analysis, open resection was associated with a higher risk of both SBO [hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.03-1.26] and operation for SBO (HR 1.12, 95% CI 0.94-1.32). This effect was even greater when characterizing laparoscopic-to-open conversions as an open approach (SBO: HR 1.34, 95% CI 1.20-1.49; SBO operation: HR 1.35, 95% CI 1.12-1.63). Most other independent risk factors were nonmodifiable and included age <60, female sex, black race, higher comorbidity burden, previous surgery, inflammatory bowel disease, and procedure type.<br />Conclusions: Open colorectal resection increases the risk of SBO compared with laparoscopy. Increased utilization of a laparoscopic approach has the potential to achieve a significant reduction in the incidence of SBO following colorectal resection.
- Subjects :
- Aged
Colonic Diseases surgery
Female
Follow-Up Studies
Humans
Incidence
Intestinal Obstruction epidemiology
Intestinal Obstruction etiology
Laparotomy statistics & numerical data
Male
Middle Aged
Rectal Diseases surgery
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States epidemiology
Colectomy adverse effects
Colectomy statistics & numerical data
Elective Surgical Procedures adverse effects
Elective Surgical Procedures statistics & numerical data
Intestinal Obstruction surgery
Intestine, Small surgery
Laparoscopy adverse effects
Laparoscopy statistics & numerical data
Laparotomy adverse effects
Tissue Adhesions prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 264
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26421688
- Full Text :
- https://doi.org/10.1097/SLA.0000000000001389