Department of Surgery.
Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Surg Laparosc Endosc Percutan Tech. 2021 Aug 18;31(6):756-759. doi: 10.1097/SLE.0000000000000984.
Some postoperative complications after laparoscopic colorectal surgery (LCS) require reoperation to be treated. However, if the timing to perform this reoperation has some influence on outcome remains elusive. The aim of this study was to analyze if the timing to perform the reoperation has some influence in postoperative outcomes.
A retrospective analysis of patients undergoing LCS and required a reoperation during the period 2000 to 2019 were included. The cohort was divided into 2 groups: early reoperation (ER): ≤48 hours or delayed reoperation (DR): ≥48 hours based on the interval between the suspicion of a complication and reoperation. Demographics, operative variables, and postoperative outcomes were compared between groups.
A total of 1843 LCS were performed, 68 (43%) were included in ER and 91 (57%) in DR. A computed tomography scan was less frequently performed in the ER (ER: 45% vs. DR: 70%; P=0.001). The rates of re-laparoscopy (ER: 86% vs. 73%; P=0.04) and negative findings in the reoperation (ER: 13% vs. DR: 1%, P=0.001) were higher in ER. There were no statistically significant differences in overall major morbidity (ER: 9% vs. DR: 21%; P=0.06) and mortality rate (ER: 4% vs. DR: 8.7%; P=0.28) between groups. The need of intensive care unit was significantly higher and the length of stay longer for patients in the DR group.
Despite a greater risk of negative findings, ER within 48 hours after the suspicion of a complication after a LCS offers higher chances of using a laparoscopic approach and it could probably provide better postoperative outcomes.
腹腔镜结直肠手术后（LCS）的一些术后并发症需要再次手术治疗。然而，再次手术的时机是否对结果有影响仍不清楚。本研究旨在分析再次手术的时机是否对术后结果有影响。
回顾性分析 2000 年至 2019 年期间行 LCS 并需要再次手术的患者。根据并发症发生后至再次手术的时间间隔，将患者分为两组：早期手术（ER）：≤48 小时或延迟手术（DR）：≥48 小时。比较两组患者的一般资料、手术相关指标和术后结局。
共行 1843 例 LCS，其中 68 例（43%）患者行 ER，91 例（57%）患者行 DR。ER 组中 CT 扫描的检查频率低于 DR 组（ER：45% vs. DR：70%；P=0.001）。ER 组再次腹腔镜手术（ER：86% vs. DR：73%；P=0.04）和再次手术阴性发现的比例（ER：13% vs. DR：1%；P=0.001）更高。两组患者的总主要发病率（ER：9% vs. DR：21%；P=0.06）和死亡率（ER：4% vs. DR：8.7%；P=0.28）无统计学差异。DR 组患者需要入住重症监护病房的比例和住院时间明显高于 ER 组。
尽管 ER 组再次手术的阴性发现风险较高，但在 LCS 后怀疑并发症发生后的 48 小时内进行 ER 可增加腹腔镜手术的机会，可能提供更好的术后结局。
