Importance of conversion for results obtained with laparoscopic colorectalsurgery

PURPOSE: The need for a conversion is a problem inherent in laparoscopic su rgery. The present study points up the significance of conversion for the r esults obtained with laparoscopic colorectal surgery and identifies the ris k factors that establish the need for conversion. METHOD: The study took th e form of a multicentric, prospective, observational study within the Lapar oscopic Colorectal Surgery Study Group. A total of 33 institutions in Germa ny, Austria, and Switzerland participated. The study period was 3.5 years. Cases were documented with the aid of a standardized questionnaire. RESULTS : Within the framework of the Laparoscopic Colorectal Surgery Study Group, a total of 1,658 patients were recruited to a multicenter study over a peri od of three and one-half years (from August 1, 1995 to February 1, 1999). T he observed conversion rate was 5.2 percent (n = 86), The patients requirin g a conversion were significantly heavier (body mass index, 26.5 vs. 24.9) than those undergoing pure laparoscopy. Resections of the rectum were assoc iated with a higher risk for conversion (20.9 vs. 13 percent). Intraoperati ve complications occurred significantly mure frequently in the conversion g roup (27.9 us. 3.8 percent). The duration of the operation was significantl y increased after conversion in a considerable proportion of the procedures performed. Postoperative morbidity (47.7 vs. 26.1 percent), mortality (3.5 vs. 1.5 percent), recovery time, and postoperative hospital stay were all negatively influenced by conversion, in part significantly. Institutions wi th experience of more than 100 laparoscopic colorectal procedures proved to have a significantly lower conversion rate than those with experience of f ewer than 100 such interventions (4.3 vs. 6.9 percent). CONCLUSION: Althoug h, of itself, conversion is not considered to be a complication of laparosc opic surgery, it is true that the postoperative course after conversion is associated with appreciably poorer results in terms of morbidity, mortality , convalescence, blood transfusion requirement, and postoperative hospital stay. The importance of experience in laparoscopic surgery can be demonstra ted on the basis of the conversion rates. Careful patient selection oriente d to the experience of the surgeon is required if we are to keep the conver sion, morbidity, and mortality rates of laparoscopic colorectal procedures as low as possible.