Department of Surgery, Ospedale Regionale Di Lugano, Lugano Regional Hospital, via Tesserete 46, 6900, Lugano, Switzerland.
Department of Visceral Surgery, CHUV, University Hospital of Lausanne, Lausanne, Switzerland.
World J Surg. 2021 May;45(5):1548-1560. doi: 10.1007/s00268-021-05970-3. Epub 2021 Jan 27.
Re-operations within 30 days after lower gastrointestinal tract surgery are associated to high morbidity and mortality. Laparoscopic approach has been reported as feasible and safe in selected patients, but comparative data to laparotomy are scarce. The aim of this study was to review our experience in laparoscopic re-operations and compare it to laparotomy.
From January 2012 to December 2016, patients undergoing a re-operation within one month after lower gastrointestinal tract surgery were included and divided into laparoscopy and laparotomy groups. The primary endpoint was successful re-operation, defined as recovery without any of the following: conversion to laparotomy, need of further invasive treatments or death. Secondary outcomes were the length of hospital stay and 30-day morbidity and mortality. Demographic, clinical and surgical characteristics were collected and analyzed.
Out of 114 patients who underwent a re-operation, 71 met the inclusion criteria. Thirty (42%) patients underwent laparoscopy and 41 (58%) laparotomy. Thirty (42%) patients were male and median age was 72.0 years-old. The initial operation was elective in 24 (34%) patients, and 50% of the initial operations were colorectal resections in both groups. Multivariate analyses showed that type of approach did not affect the re-operation success rate. Laparotomy was an independent predictor of prolonged hospital stay (OR 3.582, 95%CI 1.191-10.776, p = 0.023) and mortality (OR 13.123, 95%CI 1.301-131.579, p = 0.029).
Re-operations within 30 days after lower gastrointestinal tract surgery may be safe in selected patients, as effective as laparotomy, and associated with shorter hospital stay and lower mortality rates.
下消化道手术后 30 天内再次手术与高发病率和死亡率相关。腹腔镜方法已被报道在选择的患者中是可行和安全的，但与剖腹手术相比，比较数据很少。本研究的目的是回顾我们在腹腔镜再次手术中的经验，并将其与剖腹手术进行比较。
从 2012 年 1 月至 2016 年 12 月，纳入在下消化道手术后一个月内再次手术的患者，并分为腹腔镜组和剖腹手术组。主要终点是成功的再次手术，定义为无需任何以下治疗即可恢复：转为剖腹手术、需要进一步侵入性治疗或死亡。次要结果是住院时间和 30 天发病率和死亡率。收集并分析了人口统计学、临床和手术特征。
在 114 例再次手术的患者中，71 例符合纳入标准。30 例（42%）患者接受腹腔镜手术，41 例（58%）患者接受剖腹手术。30 例（42%）患者为男性，中位年龄为 72.0 岁。初始手术为择期手术的患者有 24 例（34%），两组中 50%的初始手术为结直肠切除术。多变量分析表明，手术方式不影响再次手术成功率。剖腹手术是住院时间延长（OR 3.582，95%CI 1.191-10.776，p=0.023）和死亡率（OR 13.123，95%CI 1.301-131.579，p=0.029）的独立预测因素。
在下消化道手术后 30 天内再次手术在选择的患者中可能是安全的，与剖腹手术一样有效，且与较短的住院时间和较低的死亡率相关。
