Background: Laparoscopic colorectal resections are being performed with increasing frequency. Several important new studies have demonstrated the benefits and safety of laparoscopic colorectal surgery, making it now the preferred approach in the surgical management of many colorectal diseases. The negative influence of conversion from laparoscopic to open colorectal resection on early postoperative morbidity has been demonstrated several times. In this study, the causes of conversion were analyzed with its influence on the postoperative morbidity, and the risk factors that establish the need for conversion were identified.
Methods: From October 2004 to November 2008, 110 patients underwent laparoscopic colorectal resections. All patients were enrolled in a prospective trial. The causes of conversion were analyzed. Statistical analysis was performed to identify factors that would predict an increased risk of conversion and the influence of conversion on the results obtained after the laparoscopic colorectal surgery.
Results: A total of 110 laparoscopic colorectal procedures for both benign and malignant diseases were performed within 48 months. Mean patient age was 60.2 years (range, 15-91). There were 72 women and 38 men. Major complications occurred in 8.6%, and 30-day-mortality rate was 1.1%. Postoperative hospitalization was 6 days (range, 3-12). Conversion occurred in 18 cases (16.3%). The mean age of the converted group was 61.5 years (range, 22-89). Postoperative hospital stay was 11 days (range, 7-18). The main reasons for conversion to open surgery were inflammation, obesity, anesthetic problems, technical difficulties & intraoperative complications. By univariate analysis, statistically significant factors defining a higher risk of conversion were male gender (p 0.0029), age from 55 to 64 years (p 0.0015) & high body mass index (p 0.0001). The duration of the operation was also significantly increased after conversion in considerable proportion of the procedures performed and this duration was also related to the time of conversion either early or late. Postoperative morbidity for converted to non-converted procedures was (23.2 vs. 12.7 percent), mortality (3.2 vs. 1.1 percent), also recovery time and postoperative   hospital   stay   were   all   negatively   influenced   by   conversion.
Conclusion: Morbidity after laparoscopic colorectal resection depends on the time of conversion: Late conversion to an open procedure correlates with an increased postoperative morbidity. Also, the conversion rate is minimized by the growing experience of the operating surgeon.