Laparoscopic bowel resection of deep infiltrating endometriosis. Comparative outcomes of a public teaching hospital and a referral private hospital

Abstract

To compare the operative outcomes of laparoscopic surgical treatment for bowel endometriosis in a public teaching hospital versus in a private referral hospital. Methods: The indications for surgery, type and time of operation, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, and postoperative complications were evaluated. Results: One hundred eighty-one patients were included (150 patients, 82.9%, in a private hospital). In the private hospital, there were more patients with infertility [56% vs. 29%; P=0.01] as an indication for surgery) and segmental resection was more common in the private hospital (48% vs. 29%, p=0.05). The average operative time (211.9±83.4 minutes vs. 128 ± 55 minutes, p<0.001) as well as the length of hospital stay (3.97±1.7 days vs. 1.56±0.85 days, p<0.001) was higher in the public hospital; the rate of conversion to open surgery was significantly lower in the private hospital (2% vs. 32.3%, p<0.001). Operations performed at the public hospital were associated with higher rates of postoperative complications (Clavien-Dindo II and II) (38.7% x 11.3%, p=0.021; OR 3.2, CI 95% 1.2-8.0). Conclusion: Laparoscopic surgery in private centers was associated with reductions in major complications, surgical times, lengths of stay and rates of conversion to open surgery compared to that in public teaching hospitals.

Author's Reply

“…Dissection: Points to be Highlighted" Dr Danny Chou MBBS 1 Dr David Rosen MBBS 1 Prof Jason Abbott B Med (Hons) PhD 2 Dr Shevy Perera MBBS 3 Assoc Prof Greg Cario MBBS 1 Dr Sarah Choi MBBS 1 Dr Michael Wynn-Williams MBBS 4 Assoc Prof George Condous MBBS MD 5 Dr Mujahid Bukhari MBBS 1 Dr Mansour Al-Shamari MBBS 6 1. Sydney Women's Endosurgery Centre, Sydney, Australia We thank Dr Parra and co-authors for their interest on our modified rectal shaving technique, Laparoscopic Reverse Submucosal Dissection (LRSD) (1), or "Sydney Shaving".…”