Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis

Pucher, Philip H.; Rahman, Saqib; Mackenzie, Hugh; Tucker, Vanessa; Mercer, Stuart

doi:10.1007/s00464-021-08803-5

Cited by 5 publications

(9 citation statements)

References 22 publications

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Section: Discussionmentioning

confidence: 99%

“…Nevertheless, data from large national databases demonstrate that right-sided disease is associated with higher mortality in those patients who receive colectomy for diverticulitis 7 . This may explain, at least in part, why the recourse to MIS is still limited in the setting of RCD as compared with left-sided disease, with low proportions of cases that are attempted laparoscopically and important conversion rates 8,14,17 . Actually, together with small bowel resection, right colectomy topped among predictive factors for unplanned conversion during major emergency laparoscopic surgery in a recent analysis of a large national database including more than 17,000 patients 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The last decade has seen the application of MIS for the treatment of abdominal emergencies growing significantly, mainly due to the increased experience of many surgical teams in advanced laparoscopic surgery and the availability of new technologies. [11][12][13][14] Still, the surgical management of acute RCD has been traditionally regarded as a technically demanding procedure for which the implementation of laparoscopy has diffused more cautiously. 6,8,9 Actually, despite the fact that a number of centers worldwide have reported promising results, general conclusions are still difficult to draw, owing to the fact that currently available data are largely derived from low-level evidence studies returning far-variable findings.…”

Section: Discussionmentioning

confidence: 99%

“…7 This may explain, at least in part, why the recourse to MIS is still limited in the setting of RCD as compared with left-sided disease, with low proportions of cases that are attempted laparoscopically and important conversion rates. 8,14,17 Actually, together with small bowel resection, right colectomy topped among predictive factors for unplanned conversion during major emergency laparoscopic surgery in a recent analysis of a large national database including more than 17,000 patients. 14 This is also consistent with the relatively high proportion of laparoscopically approached surgeries observed in the present analysis, which were switched into an open procedure.…”

Section: Referencementioning

confidence: 99%

See 3 more Smart Citations

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery

Guerra¹,

Coletta

2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Over the last decade, there has been growing diffusion of minimally invasive surgery in the setting of abdominal emergencies. However, right-colon diverticulitis is still mainly approached by conventional celiotomy. Materials and Methods: A video vignette is presented showing the details of an emergent laparoscopic right colectomy as performed to treat a 59-year-old woman who presented with clinical signs of peritonitis, and radiologic findings suggestive of acute right-colon diverticulitis complicated by perforation of the hepatic flexure and periduodenal abscess. We also aimed to evaluate the relative outcomes of laparoscopic versus conventional surgery by meta-analyzing the currently available comparative evidence on the argument. Results: A total of 2848 patients were included in the analysis, of which 979 patients received minimally invasive surgery and 1869 had conventional surgery. Laparoscopic surgery had a longer operating time and resulted in an abbreviated hospital stay. Overall, patients receiving laparoscopy had significantly lower morbidity than those whose surgery was undertaken by laparotomy, while there was no statistically significant difference in terms of postoperative mortality. Conclusions: According to the existing literature, minimally invasive surgery improves the postoperative outcomes of patients receiving surgery for right-sided colonic diverticulitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Referencementioning

confidence: 99%

See 2 more Smart Citations

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery

Guerra¹,

Coletta

2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Detailed inclusion criteria have been previously described [ 7 ]. The dataset from which cases were drawn for this study has been used to publish previously [ 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

Laparoscopy in high-risk emergency general surgery reduces intensive care stay, length of stay and mortality

Wilson

Rahman

Pucher

et al. 2023

Langenbecks Arch Surg

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Purpose Emergency general surgery patients undergoing laparoscopic surgery are at reduced risk of mortality and may require reduced length of critical care stay. This study investigated the effect of laparoscopy on high-risk patients’ post-operative care requirements. Methods Data were retrieved for all patients entered into the NELA database between 2013 and 2018. Only high-risk surgical patients (P-POSSUM predicted mortality risk of ≥ 5%) were included. Patients undergoing laparoscopic and open emergency general surgical procedures were compared using a propensity score weighting approach. Outcome measures included total length of critical care (level 3) stay, overall length of stay and inpatient mortality. Results A total of 66,517 high-risk patients received emergency major abdominal surgery. A laparoscopic procedure was attempted in 6998 (10.5%); of these, the procedure was competed laparoscopically in 3492 (49.9%) and converted to open in 3506 (50.1%). Following inverse probability treatment weighting adjustment for patient disease and treatment characteristics, high-risk patients undergoing laparoscopic surgery had a shorter median ICU stay (1 day vs 2 days p < 0.001), overall hospital length of stay (11 days vs 14 days p < 0.001) and a lower inpatient mortality (16.0% vs 18.8%, p < 0.001). They were also less likely to have a prolonged ICU stay with an OR of 0.78 (95% CI 0.74–0.83, p < 0.001). Conclusion The results of this study suggest that in patients at high risk of post-operative mortality, laparoscopic emergency bowel surgery leads to a reduced length of critical care stay, overall length of stay and inpatient mortality compared to traditional laparotomy.

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Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database

Anand

Rahman

Tomlinson

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:Emergency general surgery (EGS) admissions account for a large proportion of surgical care and represent the majority of surgical patients who suffer in-hospital mortality. Health care systems continue to experience growing demand for emergency services: one way in which this is being increasingly addressed is dedicated subspecialty teams for emergency surgical admissions, most commonly termed "emergency general surgery" in the United Kingdom. This study aims to understand the impact of the emergency general surgery model of care on outcomes from emergency laparotomies. METHODS:Data was obtained from the National Emergency Laparotomy Audit database. Patients were dichotomized into EGS hospital or non-EGS hospital. Emergency general surgery hospital is defined as a hospital where >50% of in-hours emergency laparotomy operating is performed by an emergency general surgeon. The primary outcome was in-hospital mortality. Secondary outcomes were intensive therapy unit (ITU) length of stay and duration of hospital stay. A propensity score weighting approach was used to reduce confounding and selection bias. RESULTS:There were 115,509 patients from 175 hospitals included in the final analysis. The EGS hospital care group included 5,789 patients versus 109,720 patients in the non-EGS group. Following propensity score weighting, mean standardized mean difference reduced from 0.055 to <0.001. In-hospital mortality was similar (10.8% vs. 11.1%, p = 0.094), with mean length of stay (16.7 days vs. 16.1 days, p < 0.001) and ITU stay (2.8 days vs. 2.6 days, p < 0.001) persistently longer in patients treated in EGS systems. CONCLUSION:No significant association between the emergency surgery hospital model of care and in-hospital mortality in emergency laparotomy patients was seen. There is a significant association between the emergency surgery hospital model of care and an increased length of ITU stay and overall hospital stay. Further studies are required to examine the impact of changing models of EGS delivery in the United Kingdom.

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Feasibility of laparoscopy and factors associated with conversion to open in minimally invasive emergency major abdominal surgery: population database analysis

Cited by 5 publications

References 22 publications

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery

Laparoscopic Surgery for Acute Right-colon Diverticulitis: Video Vignette and Systematic Review With Meta-analysis of Current Evidence of Minimally Invasive Versus Conventional Surgery

Laparoscopy in high-risk emergency general surgery reduces intensive care stay, length of stay and mortality

Comparison of major abdominal emergency surgery outcomes across organizational models of emergency surgical care: Analysis of the UK NELA national database

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