Laparoscopic colorrectal surgery in a private center of Bahía Blanca
Abstract
Background: Laparoscopic surgery is a fundamental approach for the treatment of colorectal diseases. It is yet to be determined if lower volume centers with trained surgeons can reproduce the results obtained by high volume centers.Aim: To analyze short-term results obtained in laparoscopic colorectal surgery, predictive factors of conversion to open surgery and reoperation.Design: Cohort, retrospective. Method: We selected patients for colorectal surgery with laparoscopic approach between October 2014 and August 2020 in a private center, in Bahia Blanca city. Excluding emergency surgeries, anal tumors and combined pathology. Conversion, readmission, and morbidity were analyzed based on demographic variables, surgical technique, and learning curve. Multivariate analysis were employed for evaluate conversion and reoperation. Results: 167 patients; 51.5% men; mean age 66.1 years; average BMI of 26.5 kg /m2; hospital stay 4 days; conversion rate 5.4%. Operative time 231.27 minutes, being significantly longer for rectal tumors (p <0.001); 9.6% rate of reoperation and 16.8% readmission; 26% of the patients presented minor postoperative complications (Clavien I-II) and 16% major complications (Clavien III-IV-V); the most frequent were: surgical site infection (21%), ileus (13.8%) and anastomotic fistula (7.8%). Mortality 3.6%. Patients with ASA ≥3 (p = 0.015) and male sex (p = 0.01) suffered more complications. Patients with anastomotic fistula were a predictive factor for reoperation (p <0.01). Male patients and ultra low anterior resection surgery had a higher rate of conversion. Conclusions: Laparoscopic surgery for colorectal diseases in our context proved to be an effective and safe procedure that allows meeting the short-term results standards established by the scientific community. Male patients and ultra low anterior resection surgeries have a higher chance of conversion. Anastomotic fistula is a positive predictive factor for reoperation.
