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首页> 外文期刊>Surgical Endoscopy >A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection.
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A defunctioning stoma significantly prolongs the length of stay in laparoscopic colorectal resection.

机译：功能失常的气孔可显着延长腹腔镜结直肠切除术的住院时间。

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BACKGROUND: Reduction in length of stay has several advantages, including healthcare costs, patient choice, and minimizing hospital acquired infections. Additionally, length of stay is a surrogate marker of rate of recovery from the physiological insult of anaesthesia and surgery and complications thereof. A well-documented short-term benefit of laparoscopic compared to open colorectal resection is reduced length of stay. METHODS: This was a review of prospectively collected data on all laparoscopic colorectal resections performed in our unit. We analyzed patients having primary colorectal anastomosis, to assess the effect of conversion compared to completion laparoscopically. Furthermore we compared those with or without diverting stoma, for the effect of stoma formation on postoperative length of stay (LOS). RESULTS: Two hundred and thirteen patients had a colorectal resection. Of these 133 (62%) were left-sided or rectal resections. Resection with primary colorectal anastomosis was undertaken in 112patients. A defunctioning stoma was performed in 13/112 (12%), and 32/112 (29%) were converted as the procedure could not be completed laparoscopically. Conversion was not significantly associated with increased LOS with weighted median of 6.5 and 6 days for conversion and no conversion, respectively. However, stoma formation significantly increased LOS to a median of 10 days compared with a median of 6 days in patients without a stoma (p = 0.001, Mann-Whitney U). CONCLUSIONS: The need for conversion, if performed in a timely and appropriate manner, has little impact on patient outcome compared to those completed laparoscopically, with no significant increase in LOS in our experience. In contrast, a diverting stoma does prolong LOS and some of the benefits of laparoscopic surgery may be lost unless patients requiring a stoma are identified preoperatively and have intensive pre- and postoperative stoma training.
机译：背景：减少住院时间具有几个优势，包括医疗保健费用，患者选择和最大限度地减少医院获得性感染。另外，停留时间是从麻醉和手术及其并发症的生理损伤中恢复的速率的替代标志。与开放式结直肠切除术相比，腹腔镜手术有一个有据可查的短期好处，即可以减少住院时间。方法：这是对在我们单位进行的所有腹腔镜大肠切除术的前瞻性收集数据的回顾。我们分析了患有原发性大肠直肠吻合术的患者，以评估其与腹腔镜手术完成相比的效果。此外，我们比较了有或没有转移造口的人，造口对术后住院时间（LOS）的影响。结果：213例患者接受了大肠切除术。其中133例（62％）是左侧或直肠切除。对112例患者进行了原发性结肠直肠吻合术的切除。由于无法通过腹腔镜完成手术，因此在13/112（12％）中进行了功能失调的造口，并转换了32/112（29％）。转换与LOS的增加没有显着相关，转换的加权中位数分别为6.5天和6天，无转换。但是，与没有造口的患者中位数为6天相比，造口的LOS显着提高至中位数10天（p = 0.001，Mann-Whitney U）。结论：与及时进行腹腔镜手术相比，如果及时且适当地进行转换，对患者预后的影响不大，而根据我们的经验，LOS并没有显着增加。相反，转移的气孔的确会延长LOS，除非在手术前对需要气孔的患者进行术前和术后的气孔训练，否则腹腔镜手术的某些益处可能会丧失。

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