Another benefit of laparoscopy a decreased risk of anastomotic leaks
Steven D Wexner MD PhD(Hon)
Surgeon, Educator, Researcher, Author, Innovator, and Communications Leader; Past Vice Chair, Board of Regents at American College of Surgeons; Chair National Accreditation Program for Rectal Cancer
During the last 26 years numerous benefits have been clearly demonstrated as associated with laparoscopy as compared to laparotomy. One of the most challenging and worrisome complications after colorectal surgery is anastomotic leak. Kiran and colleagues sought to evaluate the risk of anastomotic leakage after laparoscopic versus open colectomy. In order to evaluate this issue, they queried the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2013. Twenty-three thousand five hundred sixty-eight (23,568) patients underwent surgery. Firstly, I was quite gratified to note that even 4 to 5 years ago the majority of patients (15,256; 64.7%) underwent laparoscopic operations as compared to only 8,312 (35.3%) who underwent laparotomy. There certainly were some differences between the patients groups in that patients who underwent laparotomy tended to be more obese, to have ASA scores of 3 or 4, and to have more comorbidities such as diabetes mellitus, pulmonary disease, renal failure, hypertension, and ascites. In addition the patients who underwent laparotomy were more likely to have undergone their surgery for malignancy or diverticular disease. Nonetheless, the authors demonstrated that laparoscopic surgery was associated with 2.8% rate of anastomotic leakage as compared to 4.5% following laparotomy, a difference which was highly significant (p<0.0001). Moreover, these findings were particularly meaningful given that patients who developed an anastomotic leak were approximately ten times more likely to die within 30 days of surgery with a 30 day mortality of 5.7% in the open group as compared to 0.6% of the laparoscopic group. The authors undertook a propensity score matched analysis in which the benefit of laparoscopic surgery was confirmed. This study provides yet more important information about the benefits of laparoscopic colorectal surgery in this case for anastomotic leak. Based upon these data surgeons should endeavor to offer laparoscopic colorectal surgery to all patients unless there is some unusual mitigating circumstance. Furthermore, patients should be aware of the differences in outcomes between laparoscopy and laparotomy when elective colorectal surgery is planned.
Senior Consultant General Surgery ISH Katutura
6 年What a bias!!! Comparing sick people with healthy one!!
Former surgeon at nhs
6 年I really don’t understand how intelligent people can look at this and agree with the conclusion when all the morbidity is in the open group! The amount of selection bias is immense Lap surgery is great but not for all Don’t stigmatise those who take on the extra risks The overall leak rates were low is that a reflection of the quality of the data
Founder and Managing Director SurgicalPerformance
6 年Given these are data presented from a retrospective analysis, in your opinion what is the likelihood of selection bias influencing the results ? Val Gebski
Professor Emeritus Department of Surgery at Mount Sinai Health System
6 年Right on for sure. It is even more true if the anastomosis is intracorporeal. Leak rates for right and ileocolic are now less than 1% with intracorporeal anastomoses.
Chief of Surgery Rimini Azienda Romagna Eras CERTIFIED 2021 -2022 presso Eras SOCIETY Confirmed on 2022.
6 年I strongly agree but I don’t know why exactly! Better dissection, better vision, less stress level, less trauma Abdominal wall and what else? And finally if you put all into an Eras pathway you have the best model of surgical care. Thanks for sharing Luca