Introduction
Laparoscopic Hartmann's reversal (LHR) has recently been reported to be safer and more feasible than open Hartmann's reversal (OHR); however, there is limited data on the outcomes of LHR compared with those of OHR from Asian countries. Therefore, we aimed to clarify the postoperative outcomes of LHR compared with OHR, and additionally compare the patient outcomes post‐LHR according to the previous Hartmann's procedure (HP) approach.
Methods
Patients who underwent OHR and LHR between January 2006 and September 2020 in a single center in Japan, were retrospectively evaluated. Patient characteristics and perioperative data were collected from the medical and surgical records and assessed.
Results
Overall, 15 and 19 patients underwent OHR and LHR, respectively, between January 2006 and September 2020. LHR was associated with less blood loss (median: 15 mL vs 185 mL; P < .001) and shorter hospital stays (9 days vs 14 days; P = .023) than OHR. There was no significant difference in postoperative complications between LHR and OHR (26.3% vs 40.0%, P = .475). However, two severe anastomotic complications in LHR were observed in patients with the stump below the peritoneal reflection. No significant difference in outcomes was observed between LHR patients who underwent open and laparoscopic HP.
Conclusion
LHR resulted in positive outcomes regarding estimated blood loss and postoperative hospitalization, compared with OHR. Although the postoperative complications between LHR and OHR were not significant, patients with the stump below the peritoneal reflection may be at a high risk of anastomotic complications.
Aim
The aim of this retrospective study was to investigate the incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer.
Methods
This study involved 2017 patients with stages 0‐III colorectal cancer who underwent laparoscopic surgery at 17 Japanese hospitals between January 2010 and December 2013. We assessed the incidence of postoperative cardiovascular thrombotic and haemorrhagic complications.
Results
Laparoscopic surgeries were performed in 1152 men and 865 women with 1405 colon and 612 rectal cancers, respectively. Overall, 3%, 38%, 17%, 8%, and 9% of patients had comorbidities of heart failure, high blood pressure, diabetes, history of stroke, and vascular disease, respectively. Antithrombotic agents were being consumed by 17% of patients. The types (and perioperative rest periods) of the antithrombotic agents were aspirin in 58% (18.6 days), clopidogrel in 19% (21.1 days), cilostazol in 13% (13.3 days), and warfarin potassium in 21% (14.6 days) of cases with antithrombotic agents. Surgical time and blood loss in the total cohort were 234 minutes and 56 mL. Four cases (0.2%) had cardiovascular thrombotic complications, including one severe cardiac infarction and one stroke with major sequelae (CHADS2 scores were 2 points in both cases). Hemorrhagic complications occurred in 19 cases (0.9%). In particular, the incidence of the major gastroduodenal haemorrhagic ulcer was higher in cases with antithrombotic agents than without them (0.05% vs 0%, P = .02).
Conclusion
The incidence of cardiovascular thrombotic complications was rare, although severe cardiac infarction and stroke could occur even after minimally invasive surgery in colorectal cancer.
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