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首页> 外文期刊>Surgical Endoscopy >Conversion in laparoscopic surgery: does intraoperative complication influence outcome?
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Conversion in laparoscopic surgery: does intraoperative complication influence outcome?

机译：腹腔镜手术的转换：术中并发症会影响预后吗？

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BACKGROUND: Conversion from laparoscopy to laparotomy can be expected in a variable percentage of surgeries. Patients who experience conversion to a laparotomy may have a worse outcome than those who have a successfully completed laparoscopic procedure. This study aimed to compare the outcomes of converted cases based on whether the case was a reactive conversion (RC, due to an intraoperative complication such as bleeding or bowel injury) or a preemptive conversion (PC, due to a lack of progression or unclear anatomy). METHODS: All laparoscopic colorectal procedures converted to a laparotomy were retrospectively reviewed from data prospectively entered into an institutional review board-approved database. Patients who underwent an RC were matched with patients who underwent a PC according to age, gender, body mass index (BMI), and diagnosis. Patients who underwent a laparoscopic colorectal resection (LCR) were taken as the control group. The incidence and nature of postoperative complications, the time to liquid or regular diet, and the length of hospital stay were recorded. RESULTS: Of 962 laparoscopic procedures performed between 2000 and 2007, 222 (23.1%) converted to a laparotomy were identified. The 30 patients who had undergone an RC were matched with 60 patients who had undergone a PC and 60 patients who had undergone an LCR. The reasons for RC were bleeding in 14 cases, bowel injury in 6 cases, ureteric damage in 3 cases, splenic injury in 3 cases, and other complications in 4 cases. The patients who had undergone RC were more likely to have experienced a postoperative complication (50% vs 27%; p = 0.028), required longer time to toleration of a regular diet (6 vs 5 days; p = 0.03), and stayed longer in the hospital (8.1 vs 7.1 days; p = 0.080). CONCLUSION: Preemptive conversion is associated with a better outcome than reactive conversion. Based on this finding, it appears preferable for the surgeon to have a low threshold for performing PC rather than awaiting the need for an RC.
机译：背景：在不同百分比的手术中，可以预期从腹腔镜手术转为剖腹手术。经历开腹手术的患者可能比成功完成腹腔镜手术的患者更糟。这项研究旨在根据病例是反应性转变（RC，由于术中并发症，例如出血或肠损伤）还是先发性转变（PC，由于病情进展或解剖结构不清晰）来比较转换后病例的结果）。方法：所有前瞻性输入机构审查委员会批准的数据库中的数据进行了回顾性审查，所有腹腔镜结直肠癌手术均已转为剖腹手术。根据年龄，性别，体重指数（BMI）和诊断，将接受RC的患者与接受PC的患者相匹配。接受腹腔镜大肠切除术（LCR）的患者作为对照组。记录术后并发症的发生率和性质，流食或规律饮食的时间以及住院时间。结果：2000年至2007年进行的962例腹腔镜手术中，有222例（占23.1％）被转化为剖腹手术。 30例接受RC的患者与60例接受PC的患者和60例接受LCR的患者相匹配。 RC的原因是出血14例，肠损伤6例，输尿管损伤3例，脾损伤3例，其他并发症4例。接受RC的患者更容易发生术后并发症（50％vs 27％; p = 0.028），需要更长的时间来耐受常规饮食（6 vs 5天; p = 0.03），并且住院时间更长在医院（8.1天和7.1天; p = 0.080）。结论：抢先转换比被动转换具有更好的结果。基于此发现，对于外科医生来说，执行PC的门槛低而不是等待RC似乎更为可取。

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