Appropriate selection is essential for achieving satisfactory outcomes in laparoscopic colonic resections in emergency settings

Abstract

Dear Editor: Laparoscopic colectomy is increasingly accepted as the standard of care in the elective setting for both benign and malignant colorectal diseases. The most recent National Bowel Cancer Audit reported an uptake of just over 40 %. The use of laparoscopy in colorectal resection for cancer has been recommended by the National Institute for Healthcare and Clinical Excellence (NICE), provided it is performed by appropriately trained surgeons. Many randomised prospective studies have demonstrated the short-term benefits of laparoscopic over open colectomy for elective surgery. These include short recovery periods, early regaining of bowel function and short hospital stay, with comparable morbidity, mortality and recurrence rates [1–3]. The role of laparoscopy for emergency colorectal resection and its potential benefits remain controversial. The available studies in the literature compare the outcomes of emergency laparoscopic procedures with emergency open procedures. To the best of our knowledge, there have been no publications comparing outcomes of emergency with elective laparoscopic colectomy. We conducted a study is to examine the use of minimally invasive laparoscopic techniques in carefully selected emergency colorectal procedures and to assess its safety and feasibility when compared with elective surgery, and to assess the outcome when compared with emergency open colectomy. This is a retrospective study of a prospectively collected database. Research ethics committee approval was waived. A literature search was performed to assess the current evidence in laparoscopic emergency colectomy. The entire Ovid database was searched with the keywords Blaparoscopic^, Bcolectomy^ and Bemergency , and these were combined with the set operator BAND^. The search was completed on 19 June 2015. Thirty-one results were found and screened. Papers that were case series, case-control, cohort or randomised controlled trials of the use of emergency laparoscopic colectomy in adults were included. Fourteen papers did not meet the inclusion criteria and 9 were duplicates. All patients who underwent emergency laparoscopic colectomy, performed by one surgeon in a single district general hospital, between 2008 and 2014 were identified. Emergency open colectomy data was collected retrospectively by searching the theatre electronic coding system for the terms Bcolectomy^ and/or BHartmann’s^. The selection criteria for emergency laparoscopic surgery were a stable patient, being fit for laparoscopic procedure and the availability of experienced surgical and nursing staff. Patients with marked small-bowel dilatation or severe sepsis were excluded. Patients who underwent laparoscopic appendicectomy and laparoscopic stoma were excluded from the database. Emergency colectomy included both lifethreatening cases, booked on the emergency list as soon as possible, and urgent surgery which was defined as needed to occur before discharge of the patient. Data collected included age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) score, admission date, operation date, operation type, ICU admission, re-operation, morbidity and mortality. Statistical analysis was performed using Fisher’s exact test for categorical data and Student t test for numerical data. A total of 347 laparoscopic colectomies were performed between 2002 and 2014, of which 321 were elective. Twenty-six emergency procedures were performed after * N. Naguib nadernaguib71@yahoo.com