Laparoscopic colorectal surgery in the complicated patient

Background: Major comorbidities are recognized risk factors in colorectal surgery. We examine here the feasibility and safety of laparoscopic colorectal surgery (LC) in the complicated, high-risk patient. Methods: From July 2003 to October 2004, 107 consecutive patients undergoing LC were prospectively studied. Complicated patients were defined as age > 80 years, body mass index (BMI) > 30, and/or American Society of Anesthesiology level III or IV. A group of case-matched controls undergoing open surgery (OC) during a similar time period were retrospectively reviewed. The 2 groups were compared and assessed for major and minor morbidity and mortality. Results: Overall morbidity was higher in the OC group 52% versus 26%. Minor complications compared at 31% OC versus 9% LC and major at 21% and 17%, respectively. With LC, advancement to discharge was more rapid and discharge home more likely than to a care facility. Conclusion: With proper patient selection and laparoscopic experience, LC can be performed in the complicated patient without undue morbidity and mortality. (c) 2005 Excerpta Medica Inc. All rights reserved.