Academic Colorectal Unit, Sydney Medical School - Concord, Sydney, Australia.
Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
Br J Surg. 2017 Mar;104(4):337-346. doi: 10.1002/bjs.10469.
Returning to the operating theatre for management of early postoperative complications after colorectal surgery is an important key performance indicator. Laparoscopic surgery has benefits that may be useful in surgical emergencies. This study explored the evidence for the advantages of laparoscopic reoperation.
A systematic review was performed to identify publications reporting the outcomes of laparoscopy as a mode of reoperation for the management of early postoperative complications of colorectal surgery. The main outcomes examined were 30-day mortality, 30-day morbidity, length of hospital stay, second reoperation rate, ICU admission and stoma formation at reoperation.
After screening 3657 citations, ten non-randomized cohort studies were identified (1137 reoperations). Laparoscopic reoperation was equivalent to or better than open reoperation, with lower rates of 30-day mortality (0-4·4 versus 0-13·6 per cent), 30-day morbidity (6-40 versus 30-80 per cent), length of stay (mean(s.d.) 15·8(2·8) versus 29·1(14·5) days), ICU admission and duration of stay in the ICU. Anastomotic leak was the most common indication, after which more patients received a defunctioning loop stoma instead of an end stoma at laparoscopic than open reoperation.
Laparoscopic reoperation is feasible in selected patients, with the advantages of improved short-term outcomes.
结直肠手术后早期术后并发症的管理需要返回手术室，这是一个重要的关键绩效指标。腹腔镜手术具有在外科急症中可能有用的优势。本研究探讨了腹腔镜再次手术的优势证据。
系统检索了报告腹腔镜作为结直肠手术后早期术后并发症管理的再次手术模式的结果的出版物。主要观察结果是 30 天死亡率、30 天发病率、住院时间、二次再手术率、重症监护病房（ICU）入住率和再次手术时造口形成率。
经过筛选 3657 条引文，确定了 10 项非随机队列研究（1137 例再次手术）。腹腔镜再次手术与开放再次手术相当或更好，30 天死亡率（0-4.4 比 0-13.6%）、30 天发病率（6-40 比 30-80%）、住院时间（平均值（标准差）15.8（2.8）比 29.1（14.5）天）、ICU 入住率和 ICU 停留时间较低。吻合口漏是最常见的指征，之后腹腔镜再次手术比开放再次手术中更多的患者接受了预防性回肠造口术，而不是末端造口术。
在选择的患者中，腹腔镜再次手术是可行的，具有改善短期结局的优势。
