Short-term outcomes of laparoscopic versus open total colectomy with ileorectal anastomosis: a case-matched analysis from a nationwide database

• Published in: Techniques in coloproctology 2016-11, Vol.20 (11), p.767-773
• Main Authors: Onder, A., Benlice, C., Church, J., Kessler, H., Gorgun, E.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Case-Control Studies; Colectomy - methods; Colorectal Surgery; Databases, Factual; Endoscopy, Gastrointestinal - methods; Female; Gastroenterology; Humans; Ileostomy - methods; Laparoscopy - methods; Length of Stay; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Odds Ratio; Operative Time; Original Article; Postoperative Complications - etiology; Proctology; Rectum - surgery; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-016-1539-y

Background In the current study, we aimed to compare peri- and postoperative 30-day outcomes of patients undergoing laparoscopic versus open total colectomy with ileorectal anastomosis in a case-matched design using data procedure-targeted database. Methods Patients who underwent elective total colectomy with ileorectal anastomosis in 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were divided into two groups according to the type of surgical approach (laparoscopic and open). Laparoscopic and open groups were matched (1:1) based on age, gender, diagnosis, body mass index, and American Society of Anesthesiologists classification. Comorbidities, perioperative, and short-term (30-day) postoperative outcomes were compared between the matched groups. Results We identified 1442 patients—549 in the laparoscopic group and 893 patients in the open group. After case matching, there were 326 patients in each group. There were 48 (14.7%) patients who had conversion in the laparoscopic group. The open group had a higher proportion of patients with ascites [0 (0%) vs. 7 (2.1%) p  = 0.015], preoperative weight loss [26 (8.0%) vs. 45 (13.8%) p  = 0.018], and contaminated wound classifications [Clean/Contaminated 261 (80%) vs. 240 (74%), Contaminated 55 (16.9%) vs. 54 (16.6%), and Dirty/Infected 8 (2.5%) vs. 28 (8.6%), ( p  = 0.003)]. The laparoscopic group had a significantly longer operative time (242 ± 98 vs. 202 ± 116 min, p