The Influence of Prior Abdominal Operations on Conversion and Complication Rates in Laparoscopic Colorectal Surgery

BACKGROUND AND OBJECTIVES: A history of a prior abdominal operation is common among patients presenting for laparoscopic colorectal surgery, and its impact on conversion and complication rates has been insufficiently studied. This study compares the conversion rates of patients with and without a prior abdominal operation (PAO). METHODS: We analyzed 1000 consecutive laparoscopic colorectal resection cases. RESULTS: Complete data on past surgical history were available on 820 of 1000 patients. The overall conversion rate was 14.8% (122/820). A history of PAO was present in 347 patients (42.3%). These patients experienced a higher conversion rate compared with non-PAO patients (68/ 347, 19.6% versus 54/473, 11.4%; P<0.001; OR 1.9). Patients with PAO had a significantly higher rate of inadvertent enterotomy (5/347, 1.4% vs. 1/473, 0.2%; P=0.04; OR 6.9), a higher incidence of postoperative ileus (23/347, 6.6% vs 14/473% 3.0; P=0.012; OR 2.3), and higher reoperative rates (8/347, 2.3% vs 1/473, 0.2%; P=0.006; OR 11.1). The incidence of other complications and mortality (total 6/820, 0.7%) was similar regardless of PAO status. CONCLUSION: Having a prior abdominal operation represents a risk factor for conversion in laparoscopic colon and rectal surgery. The incidence of a successfully completed laparoscopic operation, however, remains high in previously operated on patients.