ABSTRACT
Objective To investigate the effects of early and delayed conversion to open surgery on the prognosis after laparoscopic radical resection for colorectal cancer.Methods The retrospective cohort study was conducted.The clinicopathological data of 119 patients who were converted to open surgery in laparoscopic radical resection for colorectal cancer in the ZiBo First People's Hospital from January 2008 to December 2014 were collected.There were 66 males and 53 females,aged from 20 to 84 years,with an average age of 55 years.Of the 119 patients,82 who were converted to open surgery within 60 minutes after the start of laparoscopic surgery and 37 who were converted to open surgery after 60 minutes since the start of laparoscopic surgery were allocated into early conversion group and delayed conversion group.Observation indicators:(1) surgical situations and postoperative recovery;(2) perioperative complications;(3) follow-up.Follow-up using telephone interview,mail and outpatient examination was performed to detect patients' survival once 3 months within 2 years and once a year after 2 years postoperatively up to September 2017.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the independent sample t test.Count data were represented as absolute number or percentage,and comparison between groups was analyzed using the chi-square test or Fisher exact propability.Comparison of ordinal data was analyzed using the rank sum test.The survival rate was calculated using the Kaplan-Meier method and Log-rank test was used for survival analysis.Results (1) Surgical situations and postoperative recovery:patients in the two group underwent laparoscopic radical resection of colorectal cancer successfully.The operation time,time to first defecation,duration of postoperative hospital stay were (202±44) minutes,(2.6 ± 1.1) days,(9 ± 5) days in the early conversion group and (230±45) minutes,(3.7±2.1) days,(12±6) days in the delayed conversion group,showing statistically significant differences between the two groups (t=-3.106,-3.450,-2.865,P＜0.05).The time to first flatus was (1.8± 0.6) days and (2.0 ± 0.8) days in the early conversion group and delayed conversion group,respectively,with no statistically significant difference between the two groups (t =-1.245,P＞ 0.05).(2) Perioperative complications:8.5％ (7/82) of patients in the early conversion group had perioperative complications,including 2 of early postoperative inflammatory bowel obstruction,2 of postoperative incisional infection,1 of chylous fistula,1 of urinary retention,3 of anastomotic fistula;the same patient can merge multiple complications.Patients with perioperative complications were cured after symptomatic and supportive treatment.Meanwhile,35.1％ (13/37) of patients in the delayed conversion group had perioperative complications,including 8 of early postoperative inflammatory bowel obstruction,3 of postoperative incisional infection,6 of urinary retention,3 of anastomotic fistula;the same patient can merge multiple complications.Patients with perioperative complications were cured after symptomatic and supportive treatment.There was a statistically significant difference in the incidence of perioperative complications between the two groups (x2=12.902,P＜0.05),a statistically significant difference in the early postoperative inflammatory bowel obstruction and urinary retention between the two groups (P＜0.05),and no statistically significant difference in the postoperative incisional infection,chylous fistula,anastomotic fistula between the two groups (P＞0.05).(3) Follow-up:112 out of 119 patients were followed up for 5.2-101.9 months,with a median time of 32.1 months.The 5-year survival rate was 70.5％ and 63.6％ in the 79 patients of early conversion group and 33 of delayed conversion group,showing no statistically significant difference between the two groups (x2 =0.038,P＞0.05).Conclusions Delayed conversion after 60 minutes since the start of laparoscopic surgery will lead to the slower recovery of intestinal function and prolonged hospitalization time,and increase the rates of early postoperative inflammatory intestinal obstruction and postoperative urinary retention.Therefore,a comprehensive analysis of the feasibility of laparoscopic surgery in the initial exploration is recommended and a fast decision on early conversion is necessary.
ABSTRACT
Objective To explore the influencing factors and timing of acute cholecystitis laparoscopic surgery.Methods One hundred and sixty acute cholecystitis patients treated with laparoscopic surgery were divided into group A (56 cases,performed treatment within 24 h),group B (42 cases,performed treatment at 24 -48 h),group C ( 40 cases,performed treatment at 49 -72 h),group D (22 cases,performed treatment after 72 h).The operation time,rate of conversion to laparotomy,length of stay and average costs were compared among four groups and analyzed the impact of laparoscopic surgery conversion to laparotomy.Results The rate of conversion to laparotomy of group D [ 59.09％(13/22) ] was significantly higher than that in group A [ 19.64％(11/56) ] (P ＜ 0.01 ).The operation time of group A was the shortest and group D was the longest.The length of stay of group D was significantly longer than other groups (P ＜ 0.05 ).The costs of the four groups had no significant difference(P ＞ 0.05 ).Single factor analysis showed that white blood cell (WBC) count,body temperature,timing of surgery,gallbladder neck calculi incarceration were correlated with conversion to laparotomy(P ＜ 0.05 ).Multifactor analysis showed that WBC count,timing of surgery were independent risk factors of conversion to laparotomy (P ＜ 0.05 ).Conclusions WBC count,body temperature,timing of surgery,gallbladder neck calculi incarceration are correlated with acute cholecystitis laparoscopic surgery conversion to laparotomy.While WBC count and timing of surgery are independent risk factors.The best time of laparoscopic surgery is within 72 h and WBC count ＜ 15 x 109/L.
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Objective To study the reasons and prophylaxes of conversion to laparotomy during gy-necological laparoscopic surgery. Method Clinical records of 36 cases of conversion to laparotomy out of 1143 cases of gynecological laparescopic surgery were analyzed retrospectively. Results The rate of conver-sion to laparotomy was 3.15%. The reasons of conversion to laparotomy were abdominopelvic cavity adhesion in 23 cases, technical difficulty and complication in 8 cases, malignant tumor in 3 cases, accounting for 63.89%, 22.22%, 8.33%, respectively. The rate of conversion to hparotomy in patients with a history of laparotomy was significantly higher than that without a history of laparotomy. The rate of conversion to laparoto-my in early stage of developing laparoscopic surgery was significantly higher than that in other stages. Con-clusions Abdominopelvic cavity adhesion is the primary reason of conversion to laparotomy during gyneco-logical laparoscopic surgery. Careful evaluation before surgery and improving ability of performance can de-crease the rate of conversion to laparotomy.
ABSTRACT
Objective To study the reasons of the conversion to laparotomy during laparoscopic cholecystectomy. Methods Correlative literatures were retrieved from 1994 to 1999, and were tabulated and critically appraised in terms of sample size, outcomes, and the causes of the conversion to laparotomy. Results In the 5260 cases of LCs, 169(3.21%) converted to laparotomy. The data examined revealed a bile duct injury in 22 cases (13%), bleeding in 25(14.8%), severe adhesion in 81(48%), acute choecystitis in 16(9.5%), bile leakage in 3 (1.8%), gastric cancer in 1(0.6%), carcinoma of gallbladder in 10(6%), distension of common bile duct and choledocholith in 4 (2.4%), fistula of gallbladder in 2 (1.2%), injury of stomach or bowel in 4(2.4%), unsatisfactory pneumoperitoneum in 1 (0.6%). Conclusions The major causes of the conversion to laparotomy during laparoscopic choecystectomy are severe adhesion, injury of bile duct and bleeding.