Laparoscopic colectomy: A study of open conversion

Purpose  Recent literature has indicated that patients having conversion during laparoscopic assisted colorectal resection may yield poorer clinical outcomes when compared to open or laparoscopic completed procedure.1,2 This study aimed to audit our experience of laparoscopic assisted colectomy, and assess clinical outcomes of patients undergoing conversion.

Methods  All patients having elective laparoscopic right hemicolectomy(RHC) or Anterior resections (AR) by 6 surgeons in Adelaide from 1997 to 2006 were recruited. Data pertaining to patient sex, age, ASA score, pathology, operative outcomes including operating time, conversion, reason for conversion, length of stay (LOS) and intraoperative and postoperative complications were analysed.

Results  Laparoscopic AR (n = 203) has a higher rate of open conversion than laparoscopic RHC (n = 164) (18.7% vs 10.4%, p = 0.028). In the RHC group none of the risk factors for conversion investigated were statistically significant; morbidity rates between the two groups were similar. Of AR group median operative time was significantly longer (p = 0.012) and wound morbidity rate higher in the converted group (13.2% vs 3.0%, p = 0.022). Age > 75 yo and high ASA status were significant independent risk factors for conversion in AR.

Conclusion  Open conversion in laparoscopic AR is associated with higher wound morbidity. We recommend careful considerations prior to elderly (>75 yo) patients with high ASA status for laparoscopic AR, and informing them of the increased risk and morbidity observed in conversion. In RHC, conversion is not significantly associated with the parameters investigated nor to increased morbidity.