Department of Surgery.
Division of Colorectal Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina.
Surg Laparosc Endosc Percutan Tech. 2022 Jun 1;32(3):362-367. doi: 10.1097/SLE.0000000000001052.
Laparoscopy for treating complications after laparoscopic colorectal surgery (LCS) is still controversial. Moreover, its learning curve has not been evaluated yet. The aim of this study was to analyze whether operative outcomes were influenced by the learning curve of re-laparoscopy.
A retrospective analysis of patients undergoing LCS and reoperated by a laparoscopic approach during the period 2000-2019 was performed. A cumulative sum analysis was done to determine the number of operations that must be performed to achieve a stable operative time. Based on this analysis, the cohort was divided in 3 groups. Demographics and operative variables were compared between groups.
From a total of 1911 patients undergoing LCS, 132 (7%) were included. Based on the cumulative sum analysis, the cohort was divided into the first 50 (G1), the following 52 (G2), and the last 30 (G3) patients. Less computed tomography scans were performed in G3 (G1: 72% vs. G2: 63% vs. G3: 43%; P=0.03). There were no differences in the type of operation performed between the groups. The conversion rate (G1: 18% vs. G2: 4% vs. G3: 3%; P=0.02) and the mean operative time (G1: 104 min vs. G2: 80 min vs. G3: 78 min; P=0.003) were higher in G1. Overall morbidity was lower in G3 (G1: 46% vs. G2: 63% vs. G3: 33%; P=0.01). Major morbidity, mortality, and mean length of stay remained similar in all groups.
A total of 50 laparoscopic reoperations might be needed to achieve an appropriate learning curve with reduced operative time and lower conversion rates. Further research is needed to determine the learning process of re-laparoscopy for treating complications after colorectal surgery.
腹腔镜治疗腹腔镜结直肠手术后并发症仍存在争议。此外，其学习曲线尚未得到评估。本研究旨在分析腹腔镜再手术的手术结果是否受学习曲线的影响。
对 2000 年至 2019 年期间行腹腔镜结直肠手术并再次接受腹腔镜治疗的患者进行回顾性分析。采用累积和分析来确定必须进行的手术次数，以达到稳定的手术时间。根据这项分析，将队列分为 3 组。比较组间的一般资料和手术变量。
共纳入 1911 例行腹腔镜结直肠手术的患者，其中 132 例（7%）符合条件。根据累积和分析，将队列分为前 50 例（G1）、接下来 52 例（G2）和最后 30 例（G3）。G3 组进行的计算机断层扫描较少（G1：72%比 G2：63%比 G3：43%；P=0.03）。各组间手术类型无差异。G1 组中转率（G1：18%比 G2：4%比 G3：3%；P=0.02）和平均手术时间（G1：104 分钟比 G2：80 分钟比 G3：78 分钟；P=0.003）更高。G3 组总并发症发生率较低（G1：46%比 G2：63%比 G3：33%；P=0.01）。各组间主要并发症、死亡率和平均住院时间无差异。
需要总共 50 例腹腔镜再手术，才能达到缩短手术时间和降低中转率的适当学习曲线。需要进一步研究确定腹腔镜治疗结直肠手术后并发症的再手术学习过程。
