Rotholtz Nicolas A, Laporte Mariano, Matzner Mariana, Schlottmann Francisco, Bun Maximiliano E
Department of Surgery, Hospital Alemán of Buenos Aires, Av. Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina.
Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Surg Endosc. 2022 May;36(5):3136-3140. doi: 10.1007/s00464-021-08616-6. Epub 2021 Jun 22.
Laparoscopic surgery has shown clear benefits that could also be useful in the emergency setting such as early reoperations after colorectal surgery. The aim of this study was to evaluate the safety and feasibility of laparoscopic reintervention ("relaparoscopy") (RL) to manage postoperative complications after laparoscopic colorectal surgery.
We performed a retrospective study based on a prospectively collected database from 2000 to 2019. Patients who required a reoperation after undergoing laparoscopic colorectal surgery were included. According to the approach used at the reoperation, the cohort was divided in laparoscopy (RL) and laparotomy (LPM). Demographics, hospital stay, morbidity, and mortality were analyzed.
A total of 159 patients underwent a reoperation after a laparoscopic colorectal surgery: 124 (78%) had RL and 35 (22%) LPM. Demographics were similar in both groups. Patients who underwent left colectomy were more frequently reoperated by laparoscopy (RL: 42.7% vs. LPM: 22.8%, p: 0.03). The most common finding at the reoperation was anastomotic leakage, which was treated more often by RL (RL: 67.7% vs. LPM: 25.7%, p: 0.0001), and the most common strategy was drainage and loop ileostomy (RL: 65.8% vs. LPM: 17.6%, p: 0.00001). Conversion was necessary in 12 patients (9.6%). Overall morbidity rate was 52.2%. Patients in the RL group had less postoperative severe complications (RL: 12.1% vs. LPM: 22.8, p: 0.01). Mortality rate was similar in both groups.
Relaparoscopy is feasible and safe for treating early postoperative complications, particularly anastomotic leakage after left colectomy.
腹腔镜手术已显示出明显的益处，在急诊情况下也可能有用，例如结直肠手术后的早期再次手术。本研究的目的是评估腹腔镜再次干预（“再次腹腔镜手术”，RL）处理腹腔镜结直肠手术后并发症的安全性和可行性。
我们基于2000年至2019年前瞻性收集的数据库进行了一项回顾性研究。纳入接受腹腔镜结直肠手术后需要再次手术的患者。根据再次手术所采用的方法，将队列分为腹腔镜手术（RL）组和开腹手术（LPM）组。分析人口统计学、住院时间、发病率和死亡率。
共有159例患者在腹腔镜结直肠手术后接受了再次手术：124例（78%）接受了RL，35例（22%）接受了LPM。两组的人口统计学特征相似。接受左半结肠切除术的患者更常通过腹腔镜进行再次手术（RL：42.7%对LPM：22.8%，p：0.03）。再次手术时最常见的发现是吻合口漏，RL治疗吻合口漏的频率更高（RL：67.7%对LPM：25.7%，p：0.0001），最常见的策略是引流和回肠袢造口术（RL：65.8%对LPM：17.6%，p：0.00001）。12例患者（9.6%）需要中转手术。总体发病率为52.2%。RL组患者术后严重并发症较少（RL：12.1%对LPM：22.8%，p：0.）。两组的死亡率相似。
再次腹腔镜手术治疗术后早期并发症是可行且安全的，尤其是左半结肠切除术后的吻合口漏。
