Explainable artificial intelligence prediction-based model in laparoscopic liver surgery for segments 7 and 8: an international multicenter study.

BACKGROUND: Artificial intelligence (AI) is becoming more useful as a decision-making and outcomes predictor tool. We have developed AI models to predict surgical complexity and the postoperative course in laparoscopic liver surgery for segments 7 and 8. METHODS: We included patients with lesions located in segments 7 and 8 operated by minimally invasive liver surgery from an international multi-institutional database. We have employed AI models to predict surgical complexity and postoperative outcomes. Furthermore, we have applied SHapley Additive exPlanations (SHAP) to make the AI models interpretable. Finally, we analyzed the surgeries not converted to open versus those converted to open. RESULTS: Overall, 585 patients and 22 variables were included. Multi-layer Perceptron (MLP) showed the highest performance for predicting surgery complexity and Random Forest (RF) for predicting postoperative outcomes. SHAP detected that MLP and RF gave the highest relevance to the variables "resection type" and "largest tumor size" for predicting surgery complexity and postoperative outcomes. In addition, we explored between surgeries converted to open and non-converted, finding statistically significant differences in the variables "tumor location," "blood loss," "complications," and "operation time." CONCLUSION: We have observed how the application of SHAP allows us to understand the predictions of AI models in surgical complexity and the postoperative outcomes of laparoscopic liver surgery in segments 7 and 8.

Habitual nappers and non-nappers differ in circadian rhythms of LIPE expression in abdominal adipose tissue explants.

Background and purpose: Napping is a widespread practice worldwide and has in recent years been linked to increased abdominal adiposity. Lipase E or LIPE encodes the protein hormone-sensitive lipase (HSL), an enzyme that plays an important role in lipid mobilization and exhibits a circadian expression rhythm in human adipose tissue. We hypothesized that habitual napping may impact the circadian expression pattern of LIPE, which in turn may attenuate lipid mobilization and induce abdominal fat accumulation. Methods: Abdominal adipose tissue explants from participants with obesity (n = 17) were cultured for a 24-h duration and analyzed every 4 h. Habitual nappers (n = 8) were selected to match non-nappers (n = 9) in age, sex, BMI, adiposity, and metabolic syndrome traits. Circadian LIPE expression rhythmicity was analyzed using the cosinor method. Results: Adipose tissue explants exhibited robust circadian rhythms in LIPE expression in non-nappers. In contrast, nappers had a flattened rhythm. LIPE amplitude was decreased in nappers as compared with non-nappers (71% lower). The decrease in amplitude among nappers was related to the frequency of napping (times per week) where a lower rhythm amplitude was associated with a higher napping frequency (r = -0.80; P = 0.018). Confirmatory analyses in the activity of LIPE's protein (i.e., HSL) also showed a significant rhythm in non-nappers, whereas significance in the activity of HSL was lost among nappers. Conclusion: Our results suggest that nappers display dysregulated circadian LIPE expression as well as dysregulated circadian HSL activity, which may alter lipid mobilization and contribute to increased abdominal obesity in habitual nappers.

Salud mental y calidad de sueño en los docentes de educación básica regular / Mental health and sleep quality in regular basic education teachers / Saúde mental e qualidade do sono em professores da educação básica regular

La mala calidad de sueño afecta la salud física y mental, por lo que dormir lo suficiente ayuda a activar la mente y prevenir problemas de salud. Objetivo. El propósito de este estudio fue identificar la salud mental y la calidad de sueño durante la pandemia por la COVID-19. Materiales y método. Se aplicaron tres encuestas en línea (HARS (Hamilton Anxiety Rating Scale), HDRS (Hamilton Depression Rating Scale) y PSQI (Pittsburgh Sleep Quality Index) a 203 profesores de la región de Puno entre damas y varones (102 varones y 101 mujeres) con edades de 25 años hasta 58 años (Edad promedio = 39,19 ±5,47 años), los mismos que cumplieron el aislamiento social obligatorio. Resultados. Los niveles de ansiedad identificados en el estudio fueron altos, el 55,88 % de los varones y el 60,40 % de las mujeres presentan trastornos de depresión; el 77,45 % de los varones y el 70,30 % de las mujeres presentan trastornos de ansiedad y el 47, 06 % de los varones y el 44,55 % de las mujeres presentan una pobre calidad de sueño. Conclusiones. Estos factores afectan a la salud mental de la población por lo que es necesario abordar los problemas de salud mental de las personas durante esta pandemia de COVID-19.

Poor sleep quality affects physical and mental health, so getting enough sleep helps to activate the mind and prevent health problems. Objective. The purpose of this study was to identify mental health and sleep quality during the COVID-19 pandemic. Materials and Method. Three online surveys (HARS (Hamilton Anxiety Rating Scale), HDRS (Hamilton Depression Rating Scale) and PSQI (Pittsburgh Sleep Quality Index) were applied to 203 teachers in the Puno region between women and men (102 men and 101 women) aged 25 years to 58 years (mean age = 39.19 ±5.47 years), the same who met the mandatory social isolation. Results. The levels of anxiety identified in the study were high, 55.88 % of the males and 60.40 % of the females presented depressive disorders; 77.45 % of the males and 70.30 % of the females presented anxiety disorders and 47.06 % of the males and 44.55 % of the females presented poor sleep quality. Conclusions. These factors affect the mental health of the population so it is necessary to address the mental health problems of people during this pandemic of COVID-19.

A má qualidade do sono afeta a saúde física e mental, portanto, dormir o suficiente ajuda a ativar a mente e a prevenir problemas de saúde. Objetivo. O objetivo deste estudo foi identificar a saúde mental e a qualidade do sono durante a pandemia da COVID-19. Materiais e método. Três pesquisas on-line (HARS (Hamilton Anxiety Rating Scale), HDRS (Hamilton Depression Rating Scale) e PSQI (Pittsburgh Sleep Quality Index) foram aplicadas a 203 professores e professoras da região de Puno (102 homens e 101 mulheres) com idades entre 25 e 58 anos (idade média = 39,19 ±5,47 anos), que completaram o isolamento social obrigatório. Resultados. Os níveis de ansiedade identificados no estudo eram altos, 55,88% dos homens e 60,40% das mulheres tinham distúrbios depressivos; 77,45% dos homens e 70,30% das mulheres tinham distúrbios de ansiedade e 47,06% dos homens e 44,55% das mulheres tinham má qualidade de sono. Conclusões. Estes fatores afetam a saúde mental da população e é necessário abordar os problemas de saúde mental das pessoas durante esta pandemia da COVID-19.

Full Laparoscopic Vascular Reconstruction for Portal Tumoral Invasion During a Right Hepatectomy Using the Caudal Approach.

BACKGROUND: Laparoscopic liver surgery has progressively evolved. Consequently, liver procedures are increasingly performed laparoscopically, particularly in experienced centers. However, vascular resection and reconstruction still are considered a limitation for laparoscopy1 due to the risk of bleeding and the technical difficulty. METHODS: A 72-year-old woman with a history of colorectal cancer had a 10 cm metastasis diagnosed in the right hemiliver with tumoral invasion of the right portal branch and tumor thrombus advancing to the portal confluence. After adjuvant chemotherapy and with stable disease, surgical resection was planned.2,3 Tips to avoid portal stenosis were carefully followed. RESULTS: The operation was performed with a fully laparoscopic procedure. To minimize manipulation, an in situ right hepatectomy was performed.4 The right hepatic artery was dissected and ligated. The liver transection was guided with a caudal approach of the middle hepatic vein.5 The right biliary duct was then divided, achieving an excellent exposure of the portal bifurcation. The main and left portal trunks were occluded with vascular clamps, and the right portal vein was sharply divided with scissors. The stump was sutured to minimize backflow bleeding and to cover the tumor thrombus. Then, the portal opening was transversally sutured with a 5/0 running suture. The clamps were released, and the authors observed no bleeding and an adequate caliber with no stenosis. The procedure was completed in the standard fashion. The postoperative course was uneventful, and the woman was discharged on postoperative day 3. No early or late complications were observed.6 CONCLUSIONS: In selected cases, patients who require vascular resection and reconstruction during hepatectomies can benefit from the advantages of a laparoscopic approach.

Laparoscopic radical hepatectomy and lymphadenectomy for incidental gallbladder cancer. Surgical technique with ICG fluorescence enhancement.

BACKGROUND: Radical re-resection has been demonstrated beneficial in incidental gallbladder cancer (iGBC) stages ≥ pT1b [1]. Anatomical resection (AR) of segments IVb-V is recommended, particularly for iGBC and liver-sided tumors [2]. Laparoscopically, this is a challenging procedure, as well as the regional lymphadenectomy, since inflammation from previous surgery can hinder identification of extrahepatic bile ducts. This difficult minimally invasive procedure, facilitated with indocyanine green (ICG) fluorescence enhancement [3] is herein didactically demonstrated. METHODS: A 73 y. o. female patient underwent laparoscopic cholecystectomy for cholelithiasis. An iGBC -pT2b with positive cystic node-was found. Completion radical surgery was decided. Before surgery, 1.5mg of ICG was intravenously administered. A regional lymphadenectomy (stations 5-8-9-12-13) was safely performed: ICG allowed for bile duct visualization despite scarring from previous procedure. AR (IVb-V) was performed based on a glissonian-pedicle approach. After completing the procedure, a new dose of ICG was administered to discard ischemic areas in the remnant. RESULTS: Total operative time was 359 min. Intermittent Pringle maneuver resulted in <50 ml bleeding. Hospital stay was 3 days. Pathological examination revealed no residual tumor in the liver bed. Ten lymph nodes were resected; 3 of them (2 retroportal and 1 common hepatic artery) showing tumoral invasion. After surgery, 6 cycles of adjuvant chemotherapy (Gemcitabine-Oxaliplatin) was administered. CONCLUSIONS: Laparoscopic radical surgery (AR of segments IVb-V plus regional lymphadenectomy) for iGBC is feasible and safe [4]. ICG fluorescence can be of help to identify hilar structures and rule out areas of ischemia.

Factor Structure of the AUDIM-M Dimensional Self-Concept Questionnaire in Mexican Adolescents.

Self-concept is one of the most relevant variables in the field of personality, and a negative self-perception can pose a risk to the adolescent's development. The present study aimed to analyze the psychometric properties proposed by Aguirre and collaborators for the dimensional self-concept questionnaire (AUDIM-M). The total sample was 560 adolescents from the city of Chihuahua, Chihuahua, with a mean age of 12.96 ± 0.88 years. The factor structure of the questionnaire was analyzed using confirmatory factor analysis. The analyses show that a four-factor structure is viable and adequate (GFI 0.964; RMSEA 0.057; CFI 0.950). The four-factor structure (personal self-concept, physical self-concept, social self-concept, and academic self-concept), according to statistical and substantive criteria, shows adequate indicators of reliability and validity adjustment. The model obtained coincides with that proposed by Aguirre et al. Improving adolescents' self-concept undoubtedly contributes to their quality of life, hence the need for valid and reliable instruments for its measurement; this study could be a first approach for future research.

Evidence of Validity and Reliability of the Lasher and Faulkender Anxiety about Aging Scale in Mexican Older Adults.

Anxiety about aging is an important mediating factor in attitudes and behavior toward elderly individuals as well as a mediating factor in the adjustment to one's own aging processes. The aim of this study was to analyze the factor structure, internal consistency and factorial invariance by sex of the Lasher and Faulkender Anxiety about Aging Scale. The sample consisted of 601 Mexican older adults, 394 women and 207 men, with a mean age of 70.69 ± 8.10 years. The factor structure of the questionnaire was analyzed using confirmatory factor analysis. Analyses show that a four-factor structure is feasible and adequate. The four-factor structure (fear of the elderly, psychological concerns, physical appearance and fear of loss), according to statistical and substantive criteria, showed adequate reliability and validity indicators. However, the obtained model does not fully coincide with that proposed by the questionnaire authors, although it continues to support the multi-factor component of anxiety about aging. On the other hand, the factor structure, the factor loadings and the intercepts are considered invariant in the two populations (men and women); however, there are differences between populations on the means of the physical appearance and fear of loss factors.

Individualism, Competitiveness, and Fear of Negative Evaluation in Pre-adolescents: Does the Teacher's Controlling Style Matter?

The traditional teaching style in which the teacher is in control and there is a submissive attitude in students is predominant in Mexico. The development of identity in preadolescence is subjected to social groups, which could develop interpersonal difficulties through the controlling teaching style. Although the fear of negative evaluation in students and competitive sport has been studied in education, relatively little research has been done in the area of physical education in relation to the controlling style. The purpose of this study was to investigate the correlation and predictive relationship between controlling teaching and the fear of negative evaluation mediated by the frustration of the basic psychological needs (BPN), controlled motivation, and individualism/competitiveness through the theoretical framework of self-determination theory. Participants were 1132 students in the fifth and sixth grades in public elementary schools in the state of Chihuahua, Mexico, with ages between 10 and 13 (M = 10.51 years; SD = 0.66 years). Results indicate the perceived controlling teaching style positively predicted the fear of negative evaluation in students of this study through BPN frustration, that is positively related to low-quality motivation, which is related to a higher level of individualism/competitiveness. This, in turn, is proven to be a predictor of the fear of negative evaluation. The results also discuss the promotion of the autonomy support style, avoiding the controlling teaching style, for the minimization of negative results related to the perception of fear and the development of student well-being both within and beyond the school context.

Assessing tumor response to neoadjuvant chemoradiation in rectal cancer with rectoscopy and 18F-FDG PET/CT: results from a prospective series.

INTRODUCTION: rectoscopy and 18F-FDG PET/CT as a diagnostic algorithm for the assessment of tumor response in rectal cancer after neoadjuvant chemoradiation therapy (CRT) is very useful. MATERIAL AND METHODS: this was a prospective longitudinal study in patients with locally advanced rectal cancer treated with neoadjuvant CRT. Patients were assessed after CRT completion with a digital rectal examination, proctoscopy and 18F-FDG PET/CT. Patients were subdivided as clinical (cCR) or radiologic (rCR) responders and non-responders according to tumor response. Clinical and radiological re-assessment was compared with the surgical specimen. Pathological tumor regression (pCR) grade was determined according to Mandard's classification. Of the 68 patients included, 15 (22 %) presented pCR in the surgical specimen and tumor persistence (non-PCR) was detected in the remaining 53 (78 %). Clinical assessment (DRE+ rectoscopy) identified 15 patients as cCR and 53 as non-cCR, two were false positives and two were false negatives. The overall accuracy was 94 %. 18F-FDG PET/CT identified 18 patients as rCR and 50 as non-rCR, one was a false positive and four were false negatives. The overall accuracy was 92 %. A combination of clinical findings and 18F-FDG PET/CT resulted in an accuracy of 96 %. The combination of clinical findings + 18F-FDG PET/CT was able to correctly identify all cases of pCR, with the exception of one case that presented a tumor regression of 80 %. In this series, 18F-PET-CT and clinical assessment had excellent accuracies in differentiating PCR from non-PCR after CRT completion. PET-CT combined with clinical assessment had a better accuracy than both modalities independently. 18F-FDG PET/CT is a valid tool that complements the clinical assessment of tumor response.

Severe colon ischemia in patients with severe coronavirus-19 (COVID-19)

COVID-19 is associated with severe coagulopathy. We present three cases of colonic ischemia that can be attributed to the hypercoagulable state related with SARS-CoV2 and disseminated intravascular coagulation. Three males aged 76, 68 and 56 with respiratory distress presented episodes of rectal bleeding, abdominal distension and signs of peritoneal irritation. Endoscopy (case 1) and computed tomography angiography revealed colonic ischemia. One patient (case 2) in which a computed tomography (CT) scan showed perforation of the gangrenous cecum underwent surgery. D-dimer levels were markedly increased (2,170, 2,100 and 7,360 ng/ml) in all three patients. All three patients died shortly after diagnosis

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Circadian Rhythms in Hormone-sensitive Lipase in Human Adipose Tissue: Relationship to Meal Timing and Fasting Duration.

BACKGROUND: Fat mobilization in adipose tissue (AT) has a specific timing. However, circadian rhythms in the activity of the major enzyme responsible for fat mobilization, hormone-sensitive lipase (HSL), have not been demonstrated in humans. OBJECTIVE: To analyze in a cross-sectional study whether there is an endogenous circadian rhythm in HSL activity in human AT ex vivo and whether rhythm characteristics are related to food timing or fasting duration. METHODS: Abdominal AT biopsies were obtained from 18 severely obese participants (age: 46 ± 11 years; body mass index 42 ± 6 kg/m2) who underwent laparoscopic gastric bypass. Twenty-four-hour rhythms of HSL activity and LIPE (HSL transcript in humans) expression in subcutaneous AT were analyzed together with habitual food timing and night fasting duration. RESULTS: HSL activity exhibited a circadian rhythm (P = .023) and reached the maximum value at circadian time 16 (CT) that corresponded to around midnight (relative local clock time. Similarly, LIPE displayed a circadian rhythm with acrophase also at night (P = .0002). Participants with longer night fasting duration >11.20 hours displayed almost double the amplitude (1.91 times) in HSL activity rhythm than those with short duration (P = .013); while habitual early diners (before 21:52 hours) had 1.60 times higher amplitude than late diners (P = .035). CONCLUSIONS: Our results demonstrate circadian rhythms in HSL activity and may lead to a better understanding of the intricate relationships between food timing, fasting duration and body fat regulation.

Standardized laparoscopic central hepatectomy based on hilar caudal view and root approach of the right hepatic vein.

Central hepatectomy is one of the most difficult procedures to perform laparoscopically. Rotellar and colleagues described a standardized technique, tailored specifically to laparoscopy, which facilitates its safe performance based on three principles: no liver mobilization, initial Glissonean control (based on Laennec's capsule approach) and root approach of the major veins.

P2X7 receptor induces mitochondrial failure in monocytes and compromises NLRP3 inflammasome activation during sepsis.

Sepsis is characterized by a systemic inflammatory response followed by immunosuppression of the host. Metabolic defects and mitochondrial failure are common in immunocompromised patients with sepsis. The NLRP3 inflammasome is important for establishing an inflammatory response after activation by the purinergic P2X7 receptor. Here, we study a cohort of individuals with intra-abdominal origin sepsis and show that patient monocytes have impaired NLRP3 activation by the P2X7 receptor. Furthermore, most sepsis-related deaths are among patients whose NLRP3 activation is profoundly altered. In monocytes from sepsis patients, the P2X7 receptor is associated with mitochondrial dysfunction. Furthermore, activation of the P2X7 receptor results in mitochondrial damage, which in turn inhibits NLRP3 activation by HIF-1α. We show that mortality increases in a mouse model of sepsis when the P2X7 receptor is activated in vivo. These data reveal a molecular mechanism initiated by the P2X7 receptor that contributes to NLRP3 impairment during infection.

Circadian period of luciferase expression shortens with age in human mature adipocytes from obese patients.

Daily rhythms in physiology and behavior change with age. An unresolved question is to what extent such age-related alterations in circadian organization are driven by the central clock in the suprachiasmatic nucleus (SCN), modifying timing signals to contributing peripheral tissue oscillators, and are mediated by underlying changes in the local cellular oscillators themselves. Using a bioluminescence reporter approach, we sought to determine whether circadian clock function in human adipocytes from subcutaneous (SAT) and visceral (VAT) adipose tissues changes with age. SAT and VAT biopsies were obtained from obese individuals during gastric bypass surgeries [ n = 16; body mass index: 44.8 ± 11.4 kg/m2; age: 44 ± 9 yr (range: 30-58)]. Cells were isolated and transduced with a lentiviral circadian reporter construct [brain and muscle aryl hydrocarbon receptor nuclear translocator-like:luciferase ( BMAL:LUC)], and bioluminescence was recorded over a period of 3 d. Human BMAL1:LUC adipocytes displayed a robust luminescence rhythm with comparable within-individual periods in mature and preadipocytes ( P > 0.05). With increasing age, the circadian period decreased in mature adipocytes ( P = 0.005) (ß = 4 min/yr; P < 0.05). Our ex vivo approach indicated that ageing changes the organization of endogenous circadian oscillators in human adipocytes, independent of SCN signaling.-Kolbe, I., Carrasco-Benso, M. P., López-Mínguez, J., Luján, J., Scheer, F. A. J. L., Oster, H., Garaulet, M. Circadian period of luciferase expression shortens with age in human mature adipocytes from obese patients.

Isoperistaltic versus antiperistaltic ileocolic anastomosis. Does it really matter? Results from a randomised clinical trial (ISOVANTI).

BACKGROUND: Right hemicolectomy is a very common surgery. Many studies compare different options for laparoscopic ileocolic anastomoses: intra- or extracorporeal; handsewn or stapled; side-to-side or end-to-side. However, there are no studies about the influence that peristalsis could have on this anastomosis. The aim of this study is to compare safety and feasibility of isoperistaltic and antiperistaltic anastomosis in terms of postoperative morbidity and mortality between both groups. The secondary endpoint is to compare long-term functional outcomes (chronic diarrhoea) and quality of life (GIQLI questionnaire) after a 1-year follow-up period. METHODS: A double-blind, randomised, prospective trial in patients undergoing scheduled surgery for right colon cancer with laparoscopic right hemicolectomy and isoperistaltic (ISO) or antiperistaltic (ANTI) ileocolic anastomoses. RESULTS: Hundred and eight patients were included in the study. Patients were randomised either to isoperistaltic or antiperistaltic configuration (54 ISO/ANTI). No significant differences in baseline variables were found. No differences in surgical time (130 [120-150] min ISO vs. 140 [127-160] ANTI, p = 0.481), nor in anastomotic time (19 [17-22] vs. 20 [16-25], p = 0.207) and nor in postoperative complications: 37.0% ISO versus 40.7% ANTI, (p = 0.693) were found. There were no differences in postoperative ileus (p = 0.112) nor in anastomotic leakage (3.7% vs. 5.56%, p = 1.00). Differences in "time to first flatus" and "time to first deposition" were found in favour of the antiperistaltic group (p = 0.004 and p = 0.017). Anastomotic configuration did not influence hospital stay (3 days [2-6] isoperistaltic vs. 3 [2-4] antiperistaltic, p = 0.236). During follow-up, there were no differences between the two groups at 1, 6 and 12 months (p = 0.154, p = 0.498 and p = 0.683), nor in chronic diarrhoea rates in GIQLI scores (24% ISO vs. 31.4% ANTI, p = 0.541). CONCLUSIONS: The isoperistaltic and antiperistaltic ileocolic anastomosis present similar results in terms of performance, safety and functionality. However, further studies must be carried out in order to assess relationship between postoperative ileus and anastomosis configuration. TRIAL REGISTRATION: Randomised Clinical trial (Identifier: NCT02309931).

Reintervención tras complicaciones en cirugía laparoscópica colorrectal. ¿Aporta ventajas el abordaje laparoscópico? / Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages?

Introducción: El abordaje laparoscópico en la cirugía por complicaciones colorrectales es controvertido. Sin embargo, puede proporcionar ventajas sobre la cirugía abierta. El objetivo del estudio es comparar el abordaje laparoscópico vs. el abordaje abierto en la reintervención por complicaciones tras cirugía colorrectal. Métodos: Se han analizado de forma retrospectiva, sobre una base de datos prospectiva, los pacientes intervenidos mediante cirugía laparoscópica colorrectal desde enero de 2006 a diciembre de 2015. Los pacientes que requirieron reintervenciones urgentes por complicaciones en el postoperatorio se dividieron según el abordaje (cirugía laparoscópica [CL] y cirugía abierta [CA]) y según su gravedad clínica (en función del índice de peritonitis de Mannheim [IPM]). Resultados: De 763 pacientes, 40 requirieron cirugía urgente (24 CA/16 CL). Se realizaron más ileostomías en el grupo CL (68,7% vs. 29,2%) y más colostomías en el grupo CA (37,5% vs. 6,2%), p<0,05. El IPM fue mayor en el grupo CA (27,31±6,47 [19-35] vs. 18,4±7,2 [11-24], p<0,001). La estancia hospitalaria tras la reintervención, tolerancia oral e infección de herida quirúrgica fueron favorables en CL (p<0,05). En pacientes con un IPM≤26, el abordaje laparoscópico mostró menor estancia hospitalaria, menor permanencia en unidad de críticos, tolerancia oral más temprana y menor infección de herida quirúrgica (p<0,05). Conclusiones: El abordaje laparoscópico en la reintervención por complicaciones tras cirugía colorrectal laparoscópica asocia una recuperación más rápida objetivada en un inicio precoz de tolerancia oral, menor estancia hospitalaria y menor tasa de hernia incisional en pacientes con bajo índice de gravedad (AU)

Introduction: The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. Methods: Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. Results: A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). Conclusions: A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index (AU)