Transperitoneal laparoscopy into the previously operated abdomen: effect on operative time, length of stay and complications.

PURPOSE

We evaluated the effect of previous abdominal surgery on perioperative outcomes in patients undergoing a renal/adrenal laparoscopic procedure via a transperitoneal approach.

MATERIALS AND METHODS

Renal/adrenal laparoscopic procedures via a transperitoneal approach were assessed. Medical records were reviewed to obtain operative and perioperative data.

RESULTS

Of the 190 patients 76 (40%) had previously undergone abdominal surgery. Patients with versus without an earlier abdominal operation had a longer mean hospital stay (3.8 versus 2.6 days, p = 0.002) but not longer median operative room time (median 220 versus 210 minutes, p >0.05). Operative and major complication rates were greater in patients with previous operations (16% versus 4%, p = 0.009 and 16% versus 5%, p = 0.022, respectively). Access and total complication rates were not altered (4% versus 2% and 33% versus 24%, respectively, p >0.1). An upper midline scar/ipsilateral upper quadrant scar was associated with a greater access complication rate (12% versus 0%, p = 0.029) but not a higher operative complication rate (21% versus 13%, p = 0.502). Multiple logistic regression confirmed that previous abdominal surgery was the only factor associated with operative complications.

CONCLUSIONS

Previous open abdominal operation increased the risk of operative and major complications, which most likely resulted in increased length of stay. The location of the scar impacted the access complication rate. Patients who have undergone previous open surgical procedures should be counseled on the greater risk of complications if the transperitoneal route is elected. Alternatively a retroperitoneal approach may be used.