Society of Black Academic Surgeons
Open abdominal surgery: a risk factor for future laparoscopic surgery?

https://doi.org/10.1016/j.amjsurg.2014.12.017Get rights and content

Abstract

Background

This study seeks to investigate the outcomes of laparoscopic procedures in patients with previous open abdominal surgery.

Methods

Using data from the National Surgical Quality Improvement Program (2005 to 2009), we identified patients who had undergone laparoscopic cholecystectomy, Nissen fundoplication, Heller myotomy, splenectomy, Roux-en-Y, sleeve gastrectomy, gastric band, appendectomy, or colectomy. Patients were then classified as to whether adhesiolysis (AD) was also carried out. Bivariate and multivariate analysis was used to compare groups.

Results

A total of 162,415 patients met our inclusion criteria, comprising 4,501 (3%) in the AD group and 157,913 (97%) in the nonadhesiolysis (NAD) group. Patient who had received lysis of adhesion were older, had 41% higher odds of overall complications, 17% higher adjusted mean lysis of adhesion (P < .001), and 26% higher adjusted mean operation duration (P < .001).

Conclusions

A history of previous open abdominal surgery increases the potential complication rate and hospital length of stay during subsequent laparoscopic surgery. The extent of this relationship deserves further investigation.

Section snippets

Methods

We used data from the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2009) databases. The American College of Surgeons National Surgical Quality Improvement Program collects data on preoperative risk factors, intraoperative characteristics, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures in both inpatient and outpatient settings at participating hospitals.

Using the American Medical Association's

Results

A total of 162,415 patients were studied. The majority was female (67.3%). Whites accounted for 69% of the population, Hispanic 9.9%, Blacks 9.5%, and 8.4% lacked ethnicity data. The majority of patients were between the ages of 25 and 64 years (76.9%). Over 90% (91.5%) of the study population was overweight or obese; 18.1% were smokers. Additionally, 34.8% had pre-existing cardiovascular disease and 1.9% had pulmonary disease, while .4% suffered from renal disease. The most common laparoscopic

Comments

The results derived from our analysis were not surprising. Most surgeons would agree that adhesions do complicate otherwise “routine” procedures and as such warrant extra care and attention. The details of these complications are not well described in the literature however, and this provided the impetus for our study. Much of the established data reaffirmed the consequences of adhesions following surgery with respect to bowel obstruction.5, 8, 9 Indeed, readmission for bowel obstruction

Conclusion

The analysis of the data regarding complications during laparoscopic surgery following previous open abdominal surgery was performed using a proxy devised specifically for this study. Despite the limitations of our methodology, we advocate its validity. Our results show that previous open surgery complicates future laparoscopic surgery by increasing the incidence of postoperative complications as well as increasing the operating time and overall LOS for patients.

References (16)

  • H. Ellis et al.

    Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study

    Lancet

    (1999)
  • S.G. Levrant et al.

    Anterior abdominal wall adhesions after laparotomy or laparoscopy

    J Am Assoc Gynecol Laparosc

    (1997)
  • K. Okabayashi et al.

    Adhesions after abdominal surgery: a systematic review of the incidence, distribution and severity

    Surg Today

    (2014)
  • W. Arung et al.

    Intraperitoneal adhesions after open or laparoscopic abdominal procedure: an experimental study in the rat

    J Laparoendosc Adv Surg Tech A

    (2012)
  • M.C. Parker et al.

    Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery

    Dis Colon Rectum

    (2001)
  • H. van Goor

    Consequences and complications of peritoneal adhesions

    Colorectal Dis

    (2007)
  • A. Reshef et al.

    Risk of adhesive obstruction after colorectal surgery: the benefits of the minimally invasive approach may extend well beyond the perioperative period

    Surg Endosc

    (2013)
  • A.J. Karayiannakis et al.

    Laparoscopic cholecystectomy in patients with previous upper or lower abdominal surgery

    Surg Endosc

    (2004)
There are more references available in the full text version of this article.

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The authors declare no conflicts of interest.

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