Do prior abdominal operations alter the outcome of laparoscopically assisted right hemicolectomy?

Background: Adhesions can increase the difficulty of both laparoscopic surg ery and laparotomy. The aim of this study was to compare the results of lap aroscopically assisted right hemicolectomy in patients after prior abdomina l operations (PAOs) with the results in patients without prior abdominal op erations (NPAOs). Methods: Between August 1991 and September 1998, 85 patients underwent lapa roscopically assisted right hemicolectomy. The Mann-Whitney test or Fisher' s exact test was used for statistical analysis. Results: In this study, 36 patients (21 women and 15 men), with an average age of 57.5 years (range, 15-87 years) had undergone a mean of 1.25 (range, 1 to 3) PAOs, whereas 49 patients (20 women and 29 men), with an average a ge of 60.0 years (range, 16 to 87 years) (p = 0.44) had undergone NPAOs. Ov erall in the PAO and NPAO groups, respectively, there were no significant d ifferences in the incidence of intraoperative complications (3 versus 4; p = 1.0). The mean operative time was 151 min (range, 90 to 260 min) versus 1 48 min (range, 70 to 270 min) (p = 0.66), and the mean length of stay was 6 .8 days (range, 3 to 18 days) versus 7.6 days (range, 3 to 19 days) (p = 0. 13). The procedure was converted to laparotomy (p = 0.754) for six patients in the PAO group (5 because of adhesions) and 6 patients in the NPAO-group (1 because of adhesions; p = 0.078). In the PAO group 17 patients (47%) ha d 22 post operative complications: 11 general medical and 4 wound-related c omplications. Seven patients (19%) had prolonged postoperative ileus. In th e NPAO-group 18 patients (38%) had a total of 22 complications: 7 general m edical problems, 6 wound-related complications, and 8 prolonged postoperati ve ileus, none of which were statistically significant. One patient in the NPAO group had an anastomotic leak. During a mean follow-up period of 41 mo nths (range, 3 to 89 months), three patients in the PAO group and four in t he NPAO group developed incisional hernias. Conclusions: Although there is a trend toward more conversions because of a dhesions in patients with a history of prior abdominal operations (p = 0.07 8), no increase in morbidity resulted. Therefore, laparoscopically assisted right hemicolectomy can be offered to patients with PAO, whose rate of adh esions can be expected to equal that of patients with NPAO.