PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 co...PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.展开更多
Background -The aim of the study was to assess both mortality and morbidity following resection ofmid and low rectal cancers in a French prospective multicentric study. Patients -From June to September 2002, consecuti...Background -The aim of the study was to assess both mortality and morbidity following resection ofmid and low rectal cancers in a French prospective multicentric study. Patients -From June to September 2002, consecutive patients undergoing resection for cancer of the mid-or lower rectum were prospectively included in amulticentric study. Both postoperative mortality and morbidity were recorded. Multivariate statistical analysis was performed in order to assess risk factors predictive of postoperative morbidity. Results -238 patients with a mean age of 66±13 years (range: 26-88) were included. Neoadjuvant radiotherapy was performed in 68%of the patients. Totalmesorectal excision was performed in 218 patients (92%), of whom 151 (63%) had a sphincter saving procedure. Six patients died (2.5%). Overall postoperative morbidity rate was 43%, including anastomotic leakage (11%) and reoperation (5%). Mean hospital-in-stay was 20 ±16 days (range: 3-191). Four independent risk factors of morbidity were found: perioperative fecal contamination (OR = 3.9 [1.1; 13.5]), mean operating time longer than 6 hours (OR = 4.5 [1.7; 12.1]), ASA score > 2 (OR = 3.2 [1.6; 7.9]), and smocking (OR = 3.3 [1.2; 8.9]). Conclusions -Resection of cancer involving the middle or lower rectum with sphincter saving procedures was possible in two-thirds of the patients and was associated with 2.5%mortality and 43%morbidity.展开更多
文摘PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.
文摘Background -The aim of the study was to assess both mortality and morbidity following resection ofmid and low rectal cancers in a French prospective multicentric study. Patients -From June to September 2002, consecutive patients undergoing resection for cancer of the mid-or lower rectum were prospectively included in amulticentric study. Both postoperative mortality and morbidity were recorded. Multivariate statistical analysis was performed in order to assess risk factors predictive of postoperative morbidity. Results -238 patients with a mean age of 66±13 years (range: 26-88) were included. Neoadjuvant radiotherapy was performed in 68%of the patients. Totalmesorectal excision was performed in 218 patients (92%), of whom 151 (63%) had a sphincter saving procedure. Six patients died (2.5%). Overall postoperative morbidity rate was 43%, including anastomotic leakage (11%) and reoperation (5%). Mean hospital-in-stay was 20 ±16 days (range: 3-191). Four independent risk factors of morbidity were found: perioperative fecal contamination (OR = 3.9 [1.1; 13.5]), mean operating time longer than 6 hours (OR = 4.5 [1.7; 12.1]), ASA score > 2 (OR = 3.2 [1.6; 7.9]), and smocking (OR = 3.3 [1.2; 8.9]). Conclusions -Resection of cancer involving the middle or lower rectum with sphincter saving procedures was possible in two-thirds of the patients and was associated with 2.5%mortality and 43%morbidity.
