Slovenská chirurgia 4/2013

Complications of low rectal resection (multicentric study)

Aim: To evaluate and assess the benefits of laparoscopic surgery, and to describe pitfalls of the laparoscopy in the process of low rectal resections, when compared with conventional open operative approach. Methods: Seventy nine patients with rectal carcinoma were included in this prospective study, when they underwent open (27 patients) and laparoscopic (52 patients) low rectal resection between September 2011 and August 2013 in three centres of colorectal surgery. The incidences of peroperative and early postoperative complications in relation to surgical approach were reviewed. Operating time, conversion rates (to open surgery), as well as duration of hospital stay were assessed, too. Results: Demographic parameters of patients in conventional and laparoscopic surgery groups were not significantly different, with exception of the age: patients indicated to laparoscopy were considerably younger. Mean blood loss was the highest in conventional surgery, lower at the conversion procedure and the lowest in the laparoscopic group. Median operating time was 150 minutes in the open surgery group, 194 minutes in the laparoscopic group, and 256 minutes in the conversion group. Peroperative complications occurred most frequently in the conversion group (45.5%) when compared with the laparoscopic (9.8%) and the open surgery (14.8%) groups. Early postoperative complications in the conventional (66.7%) and conversion (63.6%) groups do not differ significantly, they were noticeably lower in the laparoscopic group (19.5%). The wound infections became the most frequent postoperative complication; they occurred more frequently in patients in conventional and conversion groups than in the laparoscopic group. The highest rate of reoperations (36.4%) was in laparoscopic group converted to open surgery. Mean duration of hospital stay was 14.9 days in the open surgery group, 7.9 days in the laparoscopic group, and 14.7 days in converted patients. Conclusion: Results of the study prove lower peroperative blood loss and lower number of early postoperative complications in the laparoscopic group, particularly in a reduction of number of wound infection occurrence. On the contrary, patients converted from laparoscopy to open surgery showed the highest percentage of peroperative complications, reoperations and the longest operating time. Provided an appropriate selection of patients and compliance of TME principles, the shorter hospital stay favours the laparoscopic approach.

Keywords: low rectal resection, sphincter-saving resection, complications, laparoscopy, multicentric study.