Re-laparoscopy to Treat Early Complications After Colorectal Surgery: Is There a Learning Curve?

ABSTRACT

BACKGROUND: Laparoscopy for treating complications after laparoscopic colorectal surgery (LCS) is still controversial. Moreover, its learning curve has not been evaluated yet. The aim of this study was to analyze whether operative outcomes were influenced by the learning curve of re-laparoscopy. METHODS: A retrospective analysis of patients undergoing LCS and reoperated by a laparoscopic approach during the period 2000-2019 was performed. A cumulative sum analysis was done to determine the number of operations that must be performed to achieve a stable operative time. Based on this analysis, the cohort was divided in 3 groups. Demographics and operative variables were compared between groups. RESULTS: From a total of 1911 patients undergoing LCS, 132 (7%) were included. Based on the cumulative sum analysis, the cohort was divided into the first 50 (G1), the following 52 (G2), and the last 30 (G3) patients. Less computed tomography scans were performed in G3 (G1 72% vs. G2 63% vs. G3 43%; P=0.03). There were no differences in the type of operation performed between the groups. The conversion rate (G1 18% vs. G2 4% vs. G3 3%; P=0.02) and the mean operative time (G1 104 min vs. G2 80 min vs. G3 78 min; P=0.003) were higher in G1. Overall morbidity was lower in G3 (G1 46% vs. G2 63% vs. G3 33%; P=0.01). Major morbidity, mortality, and mean length of stay remained similar in all groups. CONCLUSIONS: A total of 50 laparoscopic reoperations might be needed to achieve an appropriate learning curve with reduced operative time and lower conversion rates. Further research is needed to determine the learning process of re-laparoscopy for treating complications after colorectal surgery.