Laparoscopic approach for emergency colon resection: a retrospective propensity score-matched study

Abstract

Abstract Background Despite its routine use in elective procedures, the role of laparoscopy in emergency colorectal surgery remains debated due to limited evidence. This study compared laparoscopic and open surgery regarding complications, mortality, and hospital stay following emergency colon operations. Methods This retrospective study included adult patients treated at Päijät–Häme Central Hospital between 2010 and 2020 who underwent emergency colon resection. Propensity score matching was used to adjust for comorbidities, prior ICU admission, surgical indication, and contamination between laparoscopic and open surgery groups. Results All together 484 patients had an emergency colorectal resection of which 85 (17.6%) were carried out laparoscopically, 31 (6.4%) were converted and 377 (76.0%) were open. In the whole cohort, Comprehensive complication index was lower among laparoscopy patients than open surgery patients if intraoperative conversion to open surgery was avoided (25.8 vs. 34.9, p  = 0.012). The subgroup analysis also showed lower CCI after laparoscopic resection for patients presented with obstruction (21.3 vs. 29.7, p  = 0.046) or colorectal cancer (21.1 vs. 29.4, p  = 0.020) A multivariable regression analysis also showed that starting the procedure laparoscopically predicted lower complication rates. Patients who had a laparoscopic resection also had shorter hospital stay (9.0 vs. 12.9 days, p  < 0.001). Patients with open surgery had significantly more wound complications (10.3% vs. 1.2%, p  = 0.010). Open surgery was also an independent risk factor for higher CCI ( p  = 0.008) and the need for intensive care ( p  = 0.027). Mortality was similar regardless of the approach in short term (30 days, p  = 0.810; 90 days, p  = 0.354) and in long-term survival ( p  = 0.466). Conclusions The laparoscopic technique in colorectal emergencies may offer similar benefits as in elective surgery, with a lower burden of total complications, less wound complications and shorter hospital stay. Laparoscopy was not associated with any unexpected harmful events.