Increased Postoperative Morbidity Associated With Prolonged Laparoscopic Colorectal Resections Is Not Increased by Resident Involvement

Kulaylat, Audrey S.; Hollenbeak, Christopher S.; Stewart, David B.

doi:10.1097/dcr.0000000000000934

Cited by 9 publications

(13 citation statements)

References 24 publications

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“…The present results showed that prolonged OT is associated with an increased risk of postoperative noninfective complications, and not linked to infective complications, anastomotic complications, and hospital stay >5 days. These data are consistent with previous findings but direct comparisons between the studies are challenging because of the cutoff value to define a prolonged operation varied in each study as well as the characteristics of the patient samples analysed (including different types of colorectal procedures and different indications for surgery) [3, 6, 9, 34, 41]. In a large retrospective cohort study, Guidolin et al [9] observed that OT was linearly associated with any type of postoperative complication.…”

Section: Discussionsupporting

confidence: 85%

“…because of the cutoff value to define a prolonged operation varied in each study as well as the characteristics of the patient samples analysed (including different types of colorectal procedures and different indications for surgery)[3,6, 9,34,41]. In a large retrospective cohort study,Guidolin et al [9] observed that OT was linearly associated with any type of postoperative complication.…”

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confidence: 99%

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Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

de’Angelis

Schena

Piccoli³

et al. 2022

Colorectal Disease

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Aim: Operation time (OT) is a key operational factor influencing surgical outcomes. The present study aimed to analyse whether OT impacts on short-term outcomes of minimally-invasive right colectomies by assessing the role of surgical approach (robotic [RRC] or laparoscopic right colectomy [LRC]), and type of ileocolic anastomosis (i.e., intracorporal [IA] or extra-corporal anastomosis [EA]). Methods: This was a retrospective analysis of the Minimally-invasivE surgery for oncological Right ColectomY (MERCY) Study Group database, which included adult patients with nonmetastatic right colon adenocarcinoma operated on by oncological RRC or LRC between January 2014 and December 2020. Univariate and multivariate analyses were used. Results:The study sample was composed of 1549 patients who were divided into three groups according to the OT quartiles: (1) First quartile, <135 min (n = 386); (2) Second and third quartiles, 135-199 min (n = 731); and (3) Fourth quartile ≥200 min (n = 432). The majority (62.7%) were LRC-EA, followed by LRC-IA (24.3%), RRC-IA (11.1%), and RRC-EA (1.9%). Independent predictors of an OT ≥ 200 min included male gender, age, obesity, diabetes, use of indocyanine green fluorescence, and IA confection. An OT ≥ 200 min was significantly associated with an increased risk of postoperative noninfective complications (AOR: 1.56; 95% CI: 1.15-2.13; p = 0.004), whereas the surgical approach and the type of anastomosis had no impact on postoperative morbidity. Conclusion:Prolonged OT is independently associated with increased odds of postoperative noninfective complications in oncological minimally-invasive right colectomy.

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Section: Discussionsupporting

confidence: 85%

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confidence: 99%

Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

de’Angelis

Schena

Piccoli³

et al. 2022

Colorectal Disease

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“…This is the first large-scale study comparing clinical characteristics and operative factors for major and minor complications of patients who underwent elective colonic resection for diverticulitis in the international multi-institutional setting. The postoperative major and minor outcomes have been described previously in various distinctive case series, such as infectious or complicated complications [15][16][17] . Until present, it has been unclear whether the severity of diverticulitis phenotype of patients or the effect of operative management has an impact either alone or combined among the major and minor complications for elective surgery internationally.…”

Section: Discussionmentioning

confidence: 84%

An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery

Altınel

Cavallaro

Ricciardi

et al. 2022

Rev. Assoc. Med. Bras.

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OBJECTIVE:We investigated surgical complications of elective surgery for diverticulitis in international multi-institution to identify a prediction model for potential opportunities of quality improvement. METHODS: We identified 1225 patients who underwent elective surgery for diverticulitis between January 2010 and January 2018. The data were obtained from the National Surgical Quality Improvement Program and the Turkish Diverticulitis Study Group Collaborative, retrospectively. RESULTS: We observed that the presence of chronic obstructive pulmonary disease (OR: 3.2, 95%CI 1.8-5.9, p<0.001) or abscess at the time of surgery (OR: 1.4, 95%CI 1.2-1.7, p£0.001) is associated with a higher rate of minor complications, while comorbidities such as dyspnea (OR: 2.8, 95%CI 1.6-4.9, p£0.001) and preoperative sepsis (OR: 4.1, 95%CI 2.3-7.3, p£0.001) are associated with major complications. The centers had similar findings in minor and major complications (OR: 0.8, 95%CI 0.5-1.4, p=0.395). The major independent predictors for complications were malnutrition (low albumin) (OR: 0.5, 95%CI 0.4-0.6, p<0.001) and the American Society of Anesthesiology score (OR: 1.7, 95%CI 1.2-2.4, p=0.002). CONCLUSION: Regarding the major and minor complications of diverticulitis of elective surgery, the malnutrition and higher American Society of Anesthesiology score showed higher impact among the quality improvement initiatives.

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“…However, it requires mobilization of the cecum, which may be an excessive procedure if partial wedge resection by LECS is otherwise possible. A previous report showed that partial cecectomy, compared with the hemicolectomy, could preserve the ileocecal valve, reduce intraoperative blood loss and postoperative morbidity, and shorten postoperative hospital stay in cases with tumors around the cecum . LECS avoids unnecessary colectomy even if the tumor is close to the cecum.…”

Section: Discussionmentioning

confidence: 99%

“…A previous report showed that partial cecectomy, compared with the hemicolectomy, could preserve the ileocecal valve, reduce intraoperative blood loss and postoperative morbidity, and shorten postoperative hospital stay in cases with tumors around the cecum. 6 LECS avoids unnecessary colectomy even if the tumor is close to the cecum. Furthermore, ileocecal resection requires a small abdominal incision to pull out the specimen and reconstruct the digestive tract, but several complications have been reported, including incisional hernia, wound infection, and adhesion relating to the small abdominal incision.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic‐endoscopic cooperative surgery for ileal lipoma: A case report

Nakanishi

Fukunaga

Nagasaki

et al. 2019

Asian J Endoscop Surgery

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This is the first report of laparoscopic‐endoscopic cooperative surgery (LECS) for an ileal tumor. A 50‐year‐old man was admitted to our hospital with a positive fecal occult blood test. Colonoscopy detected a submucosal tumor with intussusception located in the ileum, 10 cm oral from the Bauhin valve. On further examination, he was diagnosed with an ileal lipoma. There were no signs of malignancy. LECS was performed for the ileal tumor. After submucosal elevation by injecting saline solution, a mucosal incision was made circumferentially along the tumor. A full‐thickness incision was created endoscopically and laparoscopically on the circumferential mucosal incisional line. The tumor was withdrawn intraluminally by endoscopy. The defect of the ileal wall was closed laparoscopically in an axial direction with linear staplers. Histologically, the tumor was a 25‐mm ileal lipoma with negative resection margins and no malignancy.

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Increased Postoperative Morbidity Associated With Prolonged Laparoscopic Colorectal Resections Is Not Increased by Resident Involvement

Cited by 9 publications

References 24 publications

Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

Impact of operation duration on postoperative outcomes of minimally‐invasive right colectomy

An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery

Laparoscopic‐endoscopic cooperative surgery for ileal lipoma: A case report

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