Laparoscopic Conversion Research Articles

Hand-Assisted Laparoscopic Surgery (HALS) as an Alternative to Unplanned Laparoscopic Conversion to Open Surgery (LCOS) in Colectomies for Acute Diverticulitis.

In difficult colorectal cases, surgeons may opt for a hand-assisted laparoscopic (HALS) colectomy or attempt a laparoscopic surgery that may require an unplanned conversion to open (LCOS). We aimed to compare the clinical outcomes of these 2 types of surgeries. Colectomies for acute diverticulitis with a HALS or LCOS surgery were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2022 Targeted Colectomy Database. After confirming a difference in propensity scores between the cohorts, they were matched using propensity score matching (PSM) based on preoperative factors. RStudio was utilized for filtering and performing the PSM, while Minitab was used for statistical analysis. We identified 804 HALS colectomies and 284 LCOS colectomies. After PSM, both cohorts contained 284 patients. Absolute standardized mean errors for all matched factors were less than 0.1, confirming well-balanced cohorts. Following PSM, preoperative and perioperative factors were similar between both colectomy groups. Postoperatively, HALS surgeries had a shorter average length of stay (7.67 ± 0.38 vs 10.57 ± 0.41, P < 0.001) as well as lower rates of ileus (13.73% vs 22.54%, P = 0.007) and superficial surgical site infection (2.11% vs 5.28%, P = 0.045). To the best of our knowledge, this is the first national database study comparing HALS and LCOS colectomies. After accounting for confounding variables, our PSM analysis showed the benefits of HALS colectomies for acute diverticulitis. Future studies may use single-center data containing risk adjustment profiles to create an even more uniform comparison.

Survival of Patients with Right-Sided and Left-Sided Colon Cancer: Insights from an Iranian Medical Center

Objectives: We aimed to describe and compare the 12-year results of patients with colon cancer based on the Shiraz Colorectal Cancer Surgery (SCORCS) registry system in patients with a pathologically confirmed diagnosis of right-sided colon cancer (RCC) and left-sided colon cancer (LCC) who had undergone surgery. Methods: A total of 443 patients with a diagnosis of colon cancer at Shahid Faghihi Hospital, Shiraz, Iran, between 2010 and 2022, who were registered in the SCORCS system, were enrolled in the current study. The data collected included the patients' demographic characteristics, tumor site and size, degree of invasion, recurrence status, metastasis, and death. The data were analyzed using SPSS software version 21. Results: Among all patients, 61% underwent laparoscopy, 30% required conversion of laparoscopy to laparotomy, and the rest (9%) underwent laparotomy. The median follow-up time was 45 (range 25 - 87) months. Right-sided colon cancer mostly occurred in men, while LCC predominantly affected women (P = 0.04). Overall survival (P = 0.45), recurrence (P = 0.85), and metastasis (P = 0.77) were similar between the RCC and LCC groups. In both groups, the tumor stage had a significant impact on the overall survival. Conclusions: Our long-term follow-up of patients indicates that overall survival, recurrence, and metastasis are similar between RCC and LCC. However, lymphatic, vascular, and perineural invasions were more common in RCC.

Demographic and Clinical Characteristics in Patients with Elevated Neutrophil-Lymphocyte Ratio Undergoing Cholecystectomy

Introduction: Cholecystectomy, the surgical removal of the gallbladder, is a common procedure performed to address gallbladder-related conditions, primarily gallstones and cholecystitis. This study aimed to evaluate the demographic and clinical characteristics of patients with elevated neutrophil-lymphocyte ratio undergoing cholecystectomy. Methods: This prospective observational study was conducted at the various surgical units of the inpatient Department of Surgery, Dhaka Medical College Hospital, Dhaka, from July 2018 to June 2019. Patients with cholecystitis attending in the outdoor or emergency, admitted with cholecystitis in Dhaka Medical College Hospital, Dhaka were considered as the study population. A total of 50 patients were selected as study subjects by purposive sampling technique. Statistical Package for Social Science (SPSS) version 21 for Windows was used to analyze the data. A p-value &lt; 0.05 was considered to be significant. Result: Among 50 cholecystectomy patients, 68% were admitted as outpatients, and 32% via the emergency department. The predominant symptom was abdominal pain (92%), and the mean serum leukocyte count was significantly higher in the elevated NLR (≥3) group (13500/mm³ vs. 6200/mm³, p &lt;0.004). Eighty percent had gallbladder calculus, with 82% diagnosed with simple cholecystitis. Most procedures (78%) were laparoscopic, and 72% did not require drains. The mean postoperative hospital stay was 4 days, longer for the elevated NLR group (median 6 days vs. 4 days, p &lt;0.002). Complications occurred in 30% of patients, with a higher incidence in the elevated NLR group. Conclusion: The findings suggest that an elevated neutrophil-lymphocyte ratio (NLR) is linked to important clinical characteristics and outcomes, especially in older adults and males. Patients with higher NLR exhibited increased rates of laparoscopic conversion, longer operative times, and extended postoperative hospital stays. Additionally, they were more likely to need ...

Role of Laparoscopy in Evaluation of Various Blunt Abdominal Trauma

Introduction with Objective: The aim of the present study was to assess the role of laparoscopy in evaluation of various Blunt abdominal trauma (BTA) in tertiary care teaching hospital. Materials and Methods: A prospective observational study was conducted from 21st June 2016 to 21st December 2017 among 50 abdominal blunt trauma patients attending at Casualty Block, Dhaka Medical College Hospital, Dhaka, after obtaining requisite consent from the patients attendant. Data were collected through the assessment and investigation report of abdominal blunt trauma patients in the Casualty Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the role of laparoscopy in evaluation of various blunt abdominal trauma. Results: Most of the patients were from 21-30 years (36%) of age group followed by 11-20 years (32%). The median age of this study population is 27 years. Of the study population, 84% (n=42) were male and 16% (n=8) were female. Male-female ratio was 84:16. In this study, 62% (n=31) of patients underwent only laparoscopy and 38% of patients (n=19%) underwent laparoscopy followed by laparotomy. Perforation of gas containing hollow viscus (94.73%) is responsible for conversion of laparoscopy into laparotomy in patients with blunt abdominal trauma. Among 50 patients 14 patients (28%) developed post operative complications. Rate of wound infection was higher laparoscopy followed by laparotomy (n=11). One patient developed post operative collection following laparoscopy. The accuracy rate is 100% in laparoscopic evaluation of BTA in this study. Conclusion: laparoscopy is a useful modality for evaluating and managing hemodynamically stable blunt abdominal trauma patients. Medicine Today 2024, Vol.36 (2): 95-98

Laparoscopic Conversion of Gastric Plication to One Anastomosis Gastric Bypass

Laparoscopic gastric plication (LPG) is a restrictive procedure to reduce the size of the stomach by folding and suturing the stomach to decrease its capacity. LGP has a high revision rate, mostly to sleeve gastrectomy. To the best of our knowledge, this is the first such report on the bariatric population that has been never described before.The purpose of this video was to show the feasibility and safety, as well as the main technical aspects, of a laparoscopic conversion of gastric plication to One Anastomosis Gastric Bypass.

Early Successful Experiences of Surgical Conversion of Endoscopic Gastric Plication to Roux-en-Y Gastric Bypass.

The primary obesity surgery endoluminal (POSE) procedure is an innovative incision-less endoscopic bariatric procedure that is increasingly used. However, variable weight loss response and recurrence post-endoscopic bariatric procedures have at times necessitated laparoscopic bariatric conversion. The safety and approach of conversion to laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB), however, have been an active point of discussion within revisional bariatric surgery. This retrospective review of four consecutive patients is the largest description of medium-term postoperative outcomes and technical highlights of a laparoscopic conversion of POSE to RYGB. Chart review was completed to evaluate patients' post-POSE clinical course and perioperative outcomes after surgical conversion. Early data suggests varied weight loss trajectory with POSE and marked improvement in weight response after surgical conversion. Qualitative review reveals successful single-staged conversions contrary to previous smaller case series describing staged conversions involving endoscopic removal of plications followed by RYGB. Review additionally reveals key perioperative considerations for successful conversions to include intraoperative endoscopy, upper gastrointestinal fluoroscopic studies, and at times computed tomography. The latter study and laparoscopic view of the post-POSE stomach challenge the prior notion that distal POSE allows for easy revision to LSG. Our case series underscores the complex multifactorial nature of metabolic disease and the increasing importance of a conscientious approach to conversion bariatric surgery as the adoption of POSE and the bariatric patient population continues to grow.

The efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy

Objectives: To explore the efficacy and safety of laparoscopic radical gastrectomy after neoadjuvant chemotherapy combined with immunotherapy and targeted therapy in patients with gastric cancer. Methods: A retrospective analysis of clinical and pathological data of 20 patients with locally advanced gastric cancer (clinical TNM stage T3-4aN+M0) admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from July 2021 to July 2023. All patients received 3 cycles of SOX (Oxaliplatin+S-1) regimen combined with immunotherapy (Trastuzumab) and targeted therapy (Apatinib) as neoadjuvant treatment followed by laparoscopic radical gastrectomy for gastric cancer. Surgical outcomes, postoperative pathological response, and postoperative recovery were observed. Quantitative data, except for age and operation time, were expressed using Median (range). Results: Among the 20 patients, there were 18 males and 2 females, aged 41 to 73 years [(60.6±9.7) years]. All 20 patients underwent laparoscopic surgical treatment after neoadjuvant therapy, with one patient undergoing laparoscopic conversion to open total gastrectomy with partial transverse colon resection due to tumor invasion into the transverse mesocolon. Eight patients underwent totally laparoscopic radical gastrectomy, all with Billroth Ⅱ+Braun anastomosis at the distal stomach. Eleven patients underwent laparoscopic-assisted radical gastrectomy, among which total gastrectomy with Roux-en-Y anastomosis was performed in ten cases, and proximal gastrectomy with esophagogastrostomy overlap anastomosis was performed in one case. The mean operation time for the 20 patients was (165.0±34.1) minutes; intraoperative blood loss was 80 (20-100) ml; and the number of lymph nodes retrieved was 68 (21-89). Postoperative pathological TNM staging revealed stage T0N0M0 in six cases, stage Ⅰ in two cases, stage Ⅱ in three cases, and stage Ⅲ in nine cases. Six patients (30.0%) achieved pathological complete response, and nine patients (45.0%) achieved significant pathological response. The median postoperative time to flatus was 4 (1-5) days; oral intake resumed after 3 (2-5) days; and the median length of hospital stay was 13 (6-19) days. One patient developed colonic anastomotic leakage with intra-abdominal infection, and one patient developed duodenal stump leakage with intra-abdominal infection, both classified as Clavien-Dindo grade 3A complications, and improved after treatment and discharged. One patient developed gastric paresis, and two patients developed pleural effusion, classified as Clavien-Dindo grade 2 complications, and improved after treatment and discharged. There were no deaths within 30 days after discharge. Conclusions: Laparoscopic radical gastrectomy for gastric cancer after neoadjuvant treatment with the SOX regimen combined with immunotherapy and targeted therapy is safe and feasible, with satisfactory short-term efficacy. However, there is an increase in overall surgical risk and difficulty, and it is recommended to be performed in experienced gastric cancer centers.

The increasing use of minimally invasive surgery in acute general surgical conditions: A decade of results from a national data set

BackgroundTo assess the rate of uptake of acute laparoscopic surgery for common general surgical conditions using national-level data. MethodsThe use of laparoscopic surgery in the acute management of appendicitis, cholecystitis, adhesive small bowel obstruction, and inguinal hernias was assessed between 2013 and 2022 at a national level in New Zealand. ResultsLaparoscopic appendicectomy increased from 83% to 95% (P = .0002). Laparoscopic cholecystectomy increased from 94% to 96% (P = .001). Laparoscopic adhesiolysis increased from 42% to 60% (P = .001). Laparoscopic inguinal hernia repair increased from 3% to 18% (P = .004). The rate of laparoscopic conversion demonstrated a decrease for appendicectomy (1.9% to 0.24%), cholecystectomy (0.77% to 0.39%), and adhesiolysis (9% to 2.4%) across this time. The laparoscopic cohorts were all associated with a shorter and less expensive length of stay compared to the open cohort. Māori and Pacific Island patients had largely equitable or superior rates of laparoscopic use compared to the rest of the population. No changes in laparoscopic use were detected during the COVID-19 pandemic. Rates of laparoscopic cholecystectomy and appendicectomy are similar throughout the regions. The largest difference in rates detected was for adhesiolysis, which was more common in the northern region. ConclusionThere has been a statistically significant rise in the use of acute laparoscopic surgery for acute general surgical procedures. This rise is likely clinically and economically significant, particularly in appendicectomy and adhesiolysis, with rises of 12% and 17% across the 10 years, with the known associated patient and health care system benefits.

Management of a Proximal and Distal Staple Line Leak Following Sleeve Gastrectomy and a Concurrent Duodenal Ulcer by Emergency Laparoscopic Conversion to a Roux-en-Y Gastric Bypass.

Management of a Proximal and Distal Staple Line Leak Following Sleeve Gastrectomy and a Concurrent Duodenal Ulcer by Emergency Laparoscopic Conversion to a Roux-en-Y Gastric Bypass.

An interesting case report of delayed presentation of post-cholecystectomy benign biliary stricture

Background The most common cause of benign biliary stricture is bile duct injury after cholecystectomy. Benign biliary strictures are associated with a broad spectrum of signs and symptoms, ranging from subclinical disease with mild elevation of liver enzymes to complete obstruction with jaundice, pruritis, and cholangitis ultimately leading to biliary cirrhosis. The average duration for stricture development after cholecystectomy is around 7 months. This is a case report of a benign biliary stricture presenting 14 years after laparoscopic conversion to open cholecystectomy without the development of recurrent cholangitis and secondary biliary cirrhosis.

A New Technique for Jejunal Tube Insertion During Laparoscopic Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) Due to Anastomosis Leakage.

A New Technique for Jejunal Tube Insertion During Laparoscopic Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) Due to Anastomosis Leakage.

CONVERSION OF LAPAROSCOPIC APPENDECTOMY TO OPEN APPENDECTOMY IN CHILDREN REASONS AND CLINICAL OUTCOMES

This study was carried out To assess the impact of this conversion on clinical outcomes to better understand the reasons for pediatric patients' open appendectomy procedures as opposed to laparoscopic ones. This medical research study is retrospective. We conducted a retrospective study of pediatric patients (ages 1 to 18) who had appendicectomies at MMC Mardan's Department of Pediatric Surgery between January 2010 and December 2020. Patient demographics, preoperative presentation, surgical technique (open or laparoscopic), conversion reasons, intraoperative findings, postoperative problems, duration of hospital stay, and follow-up results were all recorded. The statistical analysis included logistic regression analyses, t-tests, and chi-square tests when appropriate. The research included 462 pediatric patients, of whom 268 had a laparoscopic appendectomy, and 194 underwent open appendectomy. In 56 patients (20.9%), laparoscopic Conversion to open appendectomy was necessary. The most frequent causes of Conversion were adhesion-related vision difficulties (33.9%) and complex appendicitis (46.4%). Compared to patients who had a successful laparoscopic operation, those who had laparoscopic-to-open Conversion had a substantially greater risk of postoperative problems (24.1% vs. 8.2%, p &lt; 0.001) and longer hospital admissions (mean 4.7 vs. 2.9 days, p &lt; 0.001). The results of a logistic regression study showed that older age (OR 1.22, 95% CI 1.06-1.41) and complex appendicitis (OR 3.14, 95% CI 1.56-6.33) were independent predictors of Conversion. In children, complex appendicitis and intraoperative complications often need Conversion from laparoscopic to open appendectomy. Extended hospital stays and a greater incidence of postoperative complications are linked to these patients. Optimizing results and reducing the need for Conversion need a surgeon with extensive training and expertise in patient selection.

A060 Laparoscopic Conversion of Gastric Bypass to Distal Gastric Bypass for Inadequate Weight Loss

A060 Laparoscopic Conversion of Gastric Bypass to Distal Gastric Bypass for Inadequate Weight Loss

Laparoscopic Conversion of Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass Gives Better Result Compared to an Open Approach.

Vertical banded gastroplasty (VBG) has a relatively high failure rate in the long run, requiring revisional surgery in 30-65%. A common conversion option is to Roux-en-Y gastric bypass (RYGB), which can be performed laparoscopically or open. Current literature contains small cohorts and inconclusive results. Therefore, we set out to compare our series of open and laparoscopic VBG to RYGB conversions. All conversions performed between 1996 and 2020 were included. Patients were divided into 3 groups based on conversion indication: weight recurrence (group 1), excessive weight loss (group 2), and eating/pouch difficulties (group 3). The primary outcome was postoperative complications according to the Clavien-Dindo (CD) classification. Secondary outcome was %total weight loss (%TWL) 1 to 5 years after revisional surgery. We included 205 patients (84.9% female) of whom 105 underwent laparoscopic and 100 open VBG to RYGB conversion. Twenty-three short-term complications occurred in the laparoscopic group, with 16 > CD3a. In the open group, 33 complications occurred with 12 > CD3a. Overall complications were 33.3% in laparoscopic and 64% in open patients. There were no significant differences between the laparoscopic and open group in BMI (p = 0.76) and %TWL (p = 0.694) after 5 years. After 5 years, lost to follow-up was 97% in the open group. Twenty-eight percent of patients who reached follow-up in the laparoscopic group had available data. We demonstrate that the overall complication rate is lower in the laparoscopic group compared to the open group. Regarding BMI, an improvement was achieved in both groups after 5 years.

Primary suture for patients of bile duct stones after laparoscopic biliary tract exploration: a retrospective cohort study.

There are still many physicians who are reluctant to use primary biliary suture in Laparoscopic common bile duct exploration (LCBDE) for fear of more complications. We compare and analyze the clinical effectiveness of bile duct primary suture with three laparoscopic ports and indwelling T-tube drainage (with four laparoscopic ports) in patients with choledocholithiasis after LCBDE. Clinical data of 135 patients with common bile duct (CBD) stone were compared, including general conditions, postoperative hospital stay, postoperative complications, hospitalization costs, postoperative follow-up and other indicators. Forty-eight patients underwent primary suture of bile duct (group A) and 87 were treated with external T-tube drainage (group B). There were no significant differences between the two groups neither relating to the age, gender, BMI, diameter of CBD, number of stones, preoperative bilirubin value, number of previous surgeries in preoperative, nor the operation time, residual stones, the number of cases converted from laparoscopic conversion to laparotomy. The postoperative complications like fever, bleeding, incision infection, bile duct stricture has no differences between two group. The incidence of bile leakage (p = 0.008) and postoperative electrolyte disturbance (p = 0.001) were slightly lower in group A. There were fewer postoperative complications in group A vs group B (p = 0.04). Patients in group A experienced shorter postoperative hospital stay (p < 0.001), earlier postoperative extubation (p < 0.001), lower total hospitalization costs (p = 0.03), and earlier postoperative recovery (p = 0.000). Primary suture of CBD is a safe and effective method for some patients after LCBDE.

Laparoscopic Conversion of Open Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass with Resecting the Remnant Stomach-Video Case Report.

Laparoscopic Conversion of Open Vertical Banded Gastroplasty to Roux-en-Y Gastric Bypass with Resecting the Remnant Stomach-Video Case Report.

Robot-assisted Partial Nephrectomy with the Newly Developed KangDuo Surgical Robot Versus the da Vinci Si Surgical System: A Double-center Prospective Randomized Controlled Noninferiority Trial

BackgroundThe KangDuo surgical robot (KD-SR) was recently developed in China. ObjectiveTo compare the safety and efficacy of the KD-SR versus the da Vinci Si Surgical System (DV-SS-Si) for robot-assisted partial nephrectomy (RAPN). Design, setting, and participantsA double-center prospective randomized controlled noninferiority trial of patients aged 18–75 yr with a suspicion of T1a N0M0 renal cancer (RENAL nephrometry score ≤9) was conducted. InterventionRAPN with the KD-SR versus the DV-SS-Si. Outcome measurements and statistical analysisThe primary endpoint was the success rate of operation. The operation was successful if (1) there was no open or laparoscopic conversion, (2) the warm ischemia time was <30 min for RENAL nephrometry scores of 4–6 or 40 min for RENAL nephrometry scores of 7–9, and (3) the pathological margin was negative. The secondary endpoint was the estimated glomerular filtration rate (eGFR). A threshold of 10% was set to demonstrate noninferiority. Results and limitationsFrom September 2020 to March 2021, 100 participants were enrolled, of whom 99 (49 in the KD-SR group and 50 in the DV-SS-Si group) were finally included in the full analysis set and 98 (49 in the KD-SR group and -49 in the DV-SS-Si group) in the per-protocol set. Baseline demographic and clinical characteristics were similar between the two groups. All surgeries were completed successfully. The eGFR at postoperative weeks 4–12 and adverse events were similar between the two groups. The docking time and suture time per stitch were longer in the KD-SR group. The main limitation was that a negative margin was considered as the primary outcome rather than survival. ConclusionsThe KD-SR achieved noninferior outcomes as compared with the DV-SS-Si regarding safety and efficacy for T1a tumors. Patient summaryThe first trial comparing the KangDuo surgical robot (KD-SR) versus the da Vinci Si Surgical System for robot-assisted partial nephrectomy showed that the KD-SR is a viable option for minimally invasive treatment of T1a renal tumors.

Anastomotic Gastro-Jejunal Ulcer Following One Anastomosis Gastric Bypass (OAGB): Laparoscopic Conversion to Resectional Roux-en-Y Gastric Bypass (R-RYGB).

Anastomotic Gastro-Jejunal Ulcer Following One Anastomosis Gastric Bypass (OAGB): Laparoscopic Conversion to Resectional Roux-en-Y Gastric Bypass (R-RYGB).

Is Laparoscopy Underutilized for Sigmoid Volvulus?

Minimally invasive surgery has become increasingly prevalent. However, the majority of colectomies for volvulus are still performed via an open technique. The purpose of this study is to determine whether there is a difference in outcomes between laparoscopic and open procedures for sigmoid volvulus. The American College of Surgeons National Surgical Quality Improvement Program and colectomy-targeted procedure databases were queried from 2013 to 2018. Patients undergoing partial colectomy without ileal resection for the indication of volvulus were compared based on approach (planned laparoscopic vs. planned open). The 2 groups were propensity score matched for perioperative variables. A subgroup analysis was performed comparing unplanned laparoscopic conversion to open (CTO) with planned open procedures. The primary outcomes were overall morbidity, mortality, and length of stay. Total 2493 patients were identified. Four hundred ninety-two cases began laparoscopically (20%), of which 391 were completed laparoscopically (79%). Laparoscopic approach was associated with longer operative times (133 vs. 104min, P <0.001). Laparoscopic approach was associated with decreased overall morbidity (OR: 0.71, 95% CI, 0.54 to 0.93) and decreased length of stay when >7 days (OR: 0.70, 95% CI, 0.52 to 0.94). On subgroup analysis, there was no difference in outcomes when comparing unplanned CTO to planned open approach. Laparoscopic approach is used in a fraction of cases for colonic volvulus. When utilized, the majority are completed without CTO. Laparoscopy is associated with fewer complications and shorter hospital stays. Even with unplanned conversion to open, there is no difference in outcomes compared against planned open procedures. Surgeons should consider the utilization of laparoscopy for colonic volvulus.

ERAS failure and major complications in elective colon surgery: Common risk factors.

Proper implementation and practice of an Enhanced Recovery After Surgery (ERAS) protocol streamlines perioperative management to its optimum, resulting in fewer complications and lower costs. This study aims to identify potential risk factors for the failure of ERAS and for major postoperative complications in patients with elective colon resection. This was a single center retrospective analysis including all consecutive patients for elective colon resection during June 2017 - June 2019. All patients were treated within an upgraded ERAS program. 908 patients were included. Median ERAS compliance was 67%. Over 70% compliance was associated with a significantly lower median complication index and a shorter median hospital stay and was set as threshold in further analyses. In a multivariate regression analysis, male gender, American Society of Anesthesiologists Physical Status (ASA PS) Classification IV, open surgery, and albumin level < 34 independently predicted increased risk for failure of ERAS. Furthermore, multivariate analyses revealed that male gender, cancer in the right hemicolon/transverse colon/splenic flexure, open surgery, failure to mobilize postoperatively, and administration of > 60mg oxycodone postoperatively, independently predicted increased risk of postoperative ileus. Volvulus as primary diagnosis, conversion of laparoscopy to open surgery, failure to mobilize postoperatively, and preoperative hemoglobin < 100g/l were found to independently predict increased risk of anastomotic dehiscence. We suggest that patients of male gender, high ASA class, challenged mobility, and higher risk in open surgery, be managed with powered preoperative counseling, including rigorous physiotherapy, and operated on by two senior colorectal surgeons, in order to diminish the risk of conversion to open surgery and of postoperative complications.