Applicability of laparoscopic surgery for colorectal disease

Background: The advantages of laparoscopic colorectal surgery for selected patients have been well established. However, the applicability of laparosc opic surgery in the whole population of patients with colorectal disease is not well known. Methods: A single-institution medical records review of 269 patients subjec ted to colorectal surgery was made. Of these, 206 open colorectal procedure s were performed, and data were reviewed retrospectively. In addition, 63 p atients were subjected to laparoscopy, and their data were recorded prospec tively. An analysis of the existence of factors that contraindicate laparos copic colorectal surgery was done. These factors were of two types: absolut e (urgent intervention, severe cardiopulmonary disease, advanced liver cirr hosis, tumor invasion into adjacent organs, simultaneous major surgery) and relative (midrectal tumors, tumors in the transverse colon, bulky tumors, more than two previous infraumbilical operations, previous intestinal surge ry, and previous peritonitis). Results: Factors that could contraindicate the laparoscopic approach were f ound in 118 patients (44%). The most common were urgent intervention (40%), midrectal tumors (19%), locally advanced cancer (13%), previous intestinal surgery (13%), and tumors >10 cm (6%). We considered 25% of the contraindi cations to be absolute and 19% relative. Taking these exclusion criteria in to consideration when selecting patients for laparoscopic surgery, the conv ersion rate in our initial laparoscopic series (63 cases) was 13%. Conclusion: The indication for laparoscopic surgery for patients with color ectal disease is superior to 60% (absolute 56%, relative 81%). When using a ppropriate selection criteria, the conversion rate may be maintained below 10%. Preoperative selection of patients with colorectal disease allows opti mal use of the advantages of laparoscopic surgery.