Abstract
Background: Postoperative complications are a major concern after colorectal surgery, and can lead to an increased burden on patients and the healthcare system. Complications include postoperative ileus (POI) and prolonged postoperative ileus (PPOI). There are well-established risk factors and potential modifiable risk factors that affect the incidence of POI and PPOI, including invasive techniques, operative difficulty, perioperative blood loss, and delayed mobilization. We compared the incidence of POI, PPOI, and other postoperative complications between laparoscopic colectomy and open colectomy. Methods: This retrospective review investigates 120 patients who underwent either laparoscopic or open colectomy in King AbdulAziz University Hospital in Jeddah, Saudi Arabia, between January 2016 and June 2019. Data were collected from patients’ electronic medical records. Patients were classified into laparoscopic and open colectomy groups. The main outcomes of interest were POI, PPOI and the overall complication rate. These outcomes were calculated and compared between the two groups. Results: The overall incidence of POI and PPOI was 4.2% and 15%, respectively. There was a higher incidence of POI in the laparoscopic approach group (7.2% vs. 1.5%, P=0.03); however, the incidence of PPOI was higher in the open approach group (20% vs. 9.1%, P=0.03). The open surgery group showed a higher rate of overall complications (P=0.001). The mean estimated blood loss was lower in the laparoscopy group (139.09±145.83 vs. 343.85±307.78 mL; P<0.001). Significant earlier mobilization was observed in the laparoscopic group (3.12±1.77 vs. 5.39±3.48 days; P<0.001). Conclusion: The incidence of PPOI was significantly different depending on the surgical approach; however, the laparoscopy group tolerated regular diet earlier and had better outcomes regarding postoperative complications. The laparoscopic approach was associated with earlier ambulation and was more cost-effective based on the length of the hospital stay. Further randomized studies are required to confirm superiority of the laparoscopic approach in terms of postoperative recovery.
Highlights
Postoperative complications are often inevitable following abdominal surgeries
The incidence of prolonged postoperative ileus (PPOI) was significantly different depending on the surgical approach; the laparoscopy group tolerated regular diet earlier and had better outcomes regarding postoperative complications
The laparoscopic approach was associated with earlier ambulation and was more cost-effective based on the length of the hospital stay
Summary
Postoperative complications are often inevitable following abdominal surgeries They range from altered postoperative recovery which does not require medical intervention, to life-threatening conditions requiring intensive care management and may lead to mortality.[1,2] Among these complications, postoperative ileus (POI) is still the most common postoperative problem causing delays in patient discharge, while anastomotic leak is considered the most important factor that leads to readmission within 30 days.[3] Along with other complications, POI and anastomotic leak contribute heavily to the economic burden on the healthcare system.[3] The incidence of POI across extensive studies was found to range from 10% to 30%, leading to a 29% increase in the length of stay (LOS) in the hospital.[4,5] The term ileus refers to the disability of gastrointestinal peristalsis, which is characterized by absent or decreased peristalsis that results in the accumulation of digestive secretions leading to intolerance to oral feeding, abdominal distention, abdominal pain, failure to pass flatus, absence of bowel movement, nausea, and vomiting. Significant earlier mobilization was observed in the laparoscopic group (3.12±1.77 vs. 5.39±3.48 days; P
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