Laparoscopic-assisted colorectal resections. Morbidity, conversions, complications. Results of a decade

Background: After one decade of laparoscopic resections of the colon and re ctum the parameters morbidity, conversion and complications were analyzed. The analysis of the literature comprises the results of operations performe d for benign and malignant indications. Methods: The analysis is based on the medline research of the past ten year s. Publications in German language not listed were added. Results of multic enter studies were included if differentiation by indication and dignity co uld be achieved. Surveys of different operations of the colon and rectum no t differentiated by the parameters to be analyzed were excluded. Publicatio ns of the early beginning of laparoscopic surgery were included even if not more than 10 cases were presented but the parameters described in detail. Results: Adenomas of the colon. The morbidity ranges from 0-17.4 %, the con version rate is 17.4 and 18.4 % in 23 respectively 38 patients. Sigmoid div erticulitis: Mortality 0-1.8 %. The morbidity was 16 % in the early series and was later below 10 % (8.7 and 7.3 %). In the beginning the conversion r ate was over 10 % (12.0-38.9 %) with one exception (0 %). It dropped below 10 % (4.6- 9.2 %) and was 0 % in a recent study of 64 patients. The reasons for conversion are: inflammatory mass, fistula, perforation and obesity. I ntraoperative complications are rare. The rate of postoperative complicatio ns did not change within 10 years (9.7 to 25.0 % against 7.3 to 17.0 %). Cr ohn's disease: The morbidity is around 10 % (10.6-14.0 %) and is lower in s eries with exclusively ileocoecal resections. The conversion rate is low or zero in ileocoecal resections and raises with the degree of inflammation a nd the spectrum of procedures. Colon cancer: Mortality: 0-1.9 %. The morbid ity ranges from 6.8 to 30 % and is especially high after conversions (up to 50 %). The conversion rate reflects with the range of 4.2 to 21.0 % in the beginning and 1.6 to 23.5 % later the experience of the individual surgeon . Rectal cancer: Even in large series (n = 157) the mortality of laparoscop ic rectal resections is zero. The conversion rate is 0-7.6 %; the morbidity 11.5 to 26.4 %. Reversal of Hartmann procedure: The number of cases is low , the conversion rate is around 20 %. The morbidity ranges from 14.3-41.1 % with one exception (0 %). Rectopexy: Four different techniques are applied laparoscopically. The morbidity ranges from 0 to 16 %. The conversion rate is 0-2.6 %, except one (16.0 %). Conclusion: After one decade of laparoscopic colorectal surgery there are a dvantages for benign indications (adenomas, Crohn's disease, rectopexy) whe n compared with open surgery. Disadvantages arise from conversions. Experie nce of the surgeon is a strong parameter for a successful outcome. Results of ongoing studies are awaited for malignant indications.