Comparison of the results of laparoscopic and open surgery in the reintervention of patients with severe postoperative complications
Keywords:
laparoscopy, postoperative complications, reoperation.Abstract
Introduction: Serious postoperative complications lead to reinterventions, which increase the risk of further complications and death. There are 2 methods for performing abdominal reintervention: Open surgery (OS) or laparoscopic surgery (LS).Objective: To compare the results of laparoscopic surgery and open surgery in reinterventions of patients with serious postoperative complications.
Method: Quasi-experimental study in 155 patients with severe postoperative complications. Two groups were compared: CL (n= 71) and CA (n= 84) regarding (preoperative): cause of reintervention, mean arterial pressure, heart rate and time to reintervention; and (postoperative): Complications, further reinterventions and death.
Results: Before reintervention, mean arterial pressure was similar in both groups (experimental 91.3 mmHg; control 89.5 mmHg); The percentage of cases with previous OS in the experimental group was 67.6 %, and in this group anastomotic leak (42.65 %) and postoperative peritonitis (25 %) predominated. After reintervention, surgical site infection (59.7 % vs. 16.2 %) and external intestinal fistulas (22.6 %) were higher in the control group. There were more deaths in the control group (27.4 % vs. 8.5 %) and 23 patients with new reinterventions were reported in this group, vs. 6 patients in the experimental group.
Conclusions: Laparoscopic surgery showed better results than open surgery in the reintervention of patients with serious postoperative complications; there was less use of blood products, fewer reinterventions, complications and death.
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References
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20. Talboom K, Greijdanus NG, Ponsioen CY, Tanis PJ, Bemelman WA, Hompes R. Endoscopic vacuum-assisted surgical closure (EVASC) of anastomotic defects after low anterior resection for rectal cancer; lessons learned. Surgical endoscopy [Internet]. 2022 [acceso:22/04/2023]; 36(11):8280-8289. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613741/
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26. Grasa González F, Palomo Torrero D, López Zurra M, Bollici Martínez L, Antúnez Martos S, Serratosa Gutiérrez F, et al. Abordaje actual del abdomen abierto postoperatorio [Internet]. Cir Andal. 2020 [acceso:04/04/2021];30(1):87-95. Disponible en: https://www.asacirujanos.com/documents/revista/pdf/2019/Cir_Andal_vol30_n-1_14.pdf
27. Vennix S, Abegg R, Bakker OJ, Boezem PB van den, Brokelman WJA, Sietses C, et al. Surgical re-interventions following colorectal surgery: Open versus laparoscopic management of anastomotic leakage [Internet]. J Laparoendosc Adv Surg Tech A. 2021 [acceso:21/04/2021]; 23(9):739-44. Disponible en: https://www.liebertpub.com/doi/epub/10.1089/lap.2012.0440
28. Wright DB, Koh C, Solomon M. J. Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery [Internet]. BJS. 2021 [acceso:12/01/2023]; 104:337-346. Disponible en: https://academic.oup.com/bjs/article-abstract/104/4/337/6123267
29. Weber G, Bras Harriott C, Casas MA, Sadava EE. Laparoscopic approach for the treatment of acute complications after appendectomy: a systematic review [Internet]. Minerva Surg. 2023; 78(4):433-438. DOI: 10.23736/S2724-5691.22.09835-5
30. Casas MA, Dreifuss NH, Schlottmann F. High-volume center analysis and systematic review of stump appendicitis: solving the pending issue [Internet]. Eur J Trauma Emerg Surg. 2022; 48(3):1663-1672. DOI: 10.1007/s00068-021-01707-y
31. Chang KH, Bourke MG, Kavanagh DO, Neary PC, O'Riordan JM. A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery [Internet]. Surgeon. 2022; 14(5):287-93. DOI: 10.1016/j.surge.2015.12.003
32. Cuccurullo D, Pirozzi F, Sciuto A, Bracale U, La Barbera C, Galante F, et al. Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center [Internet]. Surg Endosc. 2021; 29(7):1795-803. DOI: 10.1007/s00464-014-3862-6
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34. Elmore U, Milone M, Parise P, Velotti N, Cossu A, Puccetti F, et al. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer [Internet]. Updates Surg. 2023;75(2):429-434. DOI: 10.1007/s13304-022-01328-z
2. Dindo D, Pierre Alain C. Interés de las escalas de morbilidad en cirugía general [Internet]. Cirugía Española. 2019 [acceso:21/05/2021]; 86(5): 269-71. Disponible en: https://www.elsevier.es/es-revista-cirugia-espanola-36-pdf-S0009739X09004394
3. Espinoza GR, Espinoza GJP. Calidad en cirugía: hacia una mejor comprensión de las complicaciones quirúrgicas [Internet]. Rev Méd Chile. 2020 [acceso: 20/06/2020]; 144(6):752-7. Disponible en: https://www.revistamedicadechile.cl/index.php/rmedica/article/view/4562/2172
4. Rosales Aguilar Y, Ricardo Martínez D, Pérez Suárez C, Pérez Suárez M, Hernández Paneque Y. Reintervención por sepsis en Cirugía abdominal. 2010- 2012 [Internet]. RM. 2016 [acceso:19/08/2018]; 19(2):153-76. Disponible en: https://revmultimed.sld.cu/index.php/mtm/article/view/257/1262
5. Gomez Rosado JC. Salas Turrens , Olry de Labry Lima A. Análisis de los costes económicos asociados a las complicaciones en cirugía general y digestiva [Internet]. Cir Esp. 2022 [acceso: 29/05/2022]; 96.5:292-299. Disponible en: https://www.elsevier.es/es-revista-cirugia-espanola-36-pdf-S0009739X18300745
6. Pérez Otero K, Valdés Morejón S, Vila Comas LS. Reintervenciones por cirugía mínimamente invasiva en pacientes con complicaciones postquirúrgicas intraabdominales. En: Aniversariocimeq 2021; 2021; La Habana; Centro de Investigaciones Médico Quirúrgicas [acceso: 29/05/2022]. Disponible en: https://aniversariocimeq2021.sld.cu/index.php/ac2021/Cimeq2021/paper/viewFil-e/272/220
7. Ramos Socarrás A, Ramos Sosa R, Vargas La O F, Neyra Rodríguez C, Rosabal Estacio J, Gallardo Arzuaga R. La Cirugía de Mínimo Acceso en las reintervenciones quirúrgicas: Estudio comparativo [Internet]. RM. 2019 [acceso:11/06/2024]; 23 (3):[aprox. 13 p.]. Disponible en: https://revmultimed.sld.cu/index.php/mtm/article/view/1214
8. Neri A, Fusario D, Marano L. Clinical evaluation of the Mannheim Prognostic Index in post-operative peritonitis: a prospective cohort study [Internet]. Updates Surg. 2020; 72:1159-1166. DOI:10.1007/s13304-020-00831-58
9. World Medical Association. WMA Declaration of Helsinki - Ethical principles for medical research involving human subjects [Internet]. Brazil, Fortaleza; 2013. [acceso:01/10/2023]. Disponible en: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-or-medical-research-involving-human-subjects/
10. Guerra Macías I, Castañeda Urdaneta F, Cutié Taquechel G. Perfil clínico, quirúrgico y epidemiológico de pacientes reintervenidos [Internet]. Rev Cub Cir. 2021 [acceso: 11/12/2023]; 60(4):e1193. Disponible en: http://scielo.sld.cu/pdf/cir/v60n4/1561-2945-cir-60-04-e1193.pdf
11. Amador Fraga Y, López Martín E, Concepción Quiñones L. Reintervenciones quirúrgicas abdominales [Internet]. Medimay. 2021[acceso:20/04/2021]; 19(3):325-36. Disponible en: https://revcmhabana.sld.cu/index.php/rcmh/article/view/606/html
12. Tengberg LT, Cihoric M, Foss NB, Bay Nielsen M, Gögenur I, Henriksen R, et al. Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients [Internet]. Anaesthesia. 2017. 72(3):309-16. DOI:10.1111/anae.13721
13. Feingold D, Steele SR, Lee S, Kaiser A, Boushey R, Buie WD, et al. Practice parameters for the treatment of sigmoid diverticulitis [Internet]. Dis Colon Rectum. 2020 [acceso:11/03/2020]; 57(3):284-94. Disponible en: https://journals.lww.com/dcrjournal/citation/2014/03000/practice_parameters-_for_the_treatment_of_sigmoid.2.aspx
14. García Basulto MJ, García Rodríguez ME, Benavidez Márquez A, Koelig Padrón R. Pacientes con infección intrabdominal en la unidad de cuidados intensivos [Internet]. Rev Cub Cir. 2020 [acceso:04/04/2021]; 59(3):e_942. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932020000300009
15. Olivares MS, Rodríguez GM, Readi VA, Campaña VG. Abordaje quirúrgico y evolución posoperatoria en reintervenciones de complicaciones en cirugía colorrectal laparoscópica, 15 años de experiencia [Internet]. Rev. cir. 2022 [acceso:17/06/2024]; 74(1):73-80. Disponible en: http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S2452-45492022000100073&lng=es
16. Hochstetler LJ, Olney WJ, Bishop JM, Warriner ZD, VanHoose JD, Mynatt RP, et al. Antibiotics for Patients With a Planned Re-Laparotomy for Intra-Abdominal Infection [Internet]. Surg Infect. 2024; 25(3):192-198. DOI: 10.1089/sur.2023.255.
17. Tottoli EM, Dorati R, Genta I, Chiesa E, Pisani S. Skin wound healing process and new emerging technologies for skin wound care and regeneration [Internet]. Pharmaceutics. 2020 [acceso:11/02/2023];12(8):735. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463929/
18. Adib Y, Bensussan A, Michel L. Cutaneous Wound Healing: A Review about Innate Immune response and Current Therapeutic Applications [Internet]. Media Inflamm. 2022; 25: [aprox.12p]. DOI: 10.1155/2022/5344085
19. León Asdrúbal SB, Juárez de la Torre JC, Navarro Tovar F, Heredia Montaño M, Quintero Cabrera JE. Reintervenciones quirúrgicas abdominales no planeadas en el Servicio de Cirugía General del Hospital Universitario de Puebla [Internet]. Gac Med Mex. 2020 [acceso:04/04/2021]; 152:508-15. Disponible en: https://www.medigraphic.com/pdfs/gaceta/gm-2016/gm164l.pdf
20. Talboom K, Greijdanus NG, Ponsioen CY, Tanis PJ, Bemelman WA, Hompes R. Endoscopic vacuum-assisted surgical closure (EVASC) of anastomotic defects after low anterior resection for rectal cancer; lessons learned. Surgical endoscopy [Internet]. 2022 [acceso:22/04/2023]; 36(11):8280-8289. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9613741/
21. Ibáñez N, Abrisqueta J. Reintervención tras complicaciones en cirugía laparoscópica colorrectal. Aporta ventajas el abordaje laparoscópico? [Internet]. Cir Esp. 2020 [acceso:21/04/2021]; 96(2):110-7. Disponible en: https://www.elsevier.es/es-revista-cirugia-espanola-36-articulo-reintervencion-tras-complicaciones-cirugia-laparoscopica-S0009739X17302877
22. Lavikainen LI, Guyatt GH, Sallinen VJ, Karanicolas PJ, Couban RJ, Singh T, et al. Systematic Reviews and Meta-analyses of the Procedure-specific Risks of Thrombosis and Bleeding in General Abdominal, Colorectal, Upper Gastrointestinal, and Hepatopancreatobiliary Surgery [Internet]. Ann Surg. 2024 [acceso:10/08/ 2024]; 279(2):213-225. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782937/
23. García Gómez ML, Ten Tusscher K. Multi-scale mechanisms driving root regeneration: From regeneration competence to tissue repatterning [Internet]. Plant J. 2024. 119(3):1183-1196. DOI: 10.1111/tpj.16860
24. Galloso Cueto GL, Lantigua Godoy A, Alfonso Moya O, Sánchez Maya AY. Papel de la cirugía video laparoscópica en la colecistitis aguda [Internet]. Rev Méd Electrón. 2021 [acceso: 06/01/2020]; 33(3):[aprox. 10 p.]. Disponible en: https://revmedicaelectronica.sld.cu/index.php/rme/article/view/825/html
25. Rasslan R, de Oliveira F, Parra J, et al. Damage control surgery in non-traumatic abdominal emergencies: prognostic value of SOFA, APACHEII, and Mannheim peritonitis index [Internet]. Updates Surg. 2024. DOI: 10.1007/s13304-024-01984-3
26. Grasa González F, Palomo Torrero D, López Zurra M, Bollici Martínez L, Antúnez Martos S, Serratosa Gutiérrez F, et al. Abordaje actual del abdomen abierto postoperatorio [Internet]. Cir Andal. 2020 [acceso:04/04/2021];30(1):87-95. Disponible en: https://www.asacirujanos.com/documents/revista/pdf/2019/Cir_Andal_vol30_n-1_14.pdf
27. Vennix S, Abegg R, Bakker OJ, Boezem PB van den, Brokelman WJA, Sietses C, et al. Surgical re-interventions following colorectal surgery: Open versus laparoscopic management of anastomotic leakage [Internet]. J Laparoendosc Adv Surg Tech A. 2021 [acceso:21/04/2021]; 23(9):739-44. Disponible en: https://www.liebertpub.com/doi/epub/10.1089/lap.2012.0440
28. Wright DB, Koh C, Solomon M. J. Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery [Internet]. BJS. 2021 [acceso:12/01/2023]; 104:337-346. Disponible en: https://academic.oup.com/bjs/article-abstract/104/4/337/6123267
29. Weber G, Bras Harriott C, Casas MA, Sadava EE. Laparoscopic approach for the treatment of acute complications after appendectomy: a systematic review [Internet]. Minerva Surg. 2023; 78(4):433-438. DOI: 10.23736/S2724-5691.22.09835-5
30. Casas MA, Dreifuss NH, Schlottmann F. High-volume center analysis and systematic review of stump appendicitis: solving the pending issue [Internet]. Eur J Trauma Emerg Surg. 2022; 48(3):1663-1672. DOI: 10.1007/s00068-021-01707-y
31. Chang KH, Bourke MG, Kavanagh DO, Neary PC, O'Riordan JM. A systematic review of the role of re-laparoscopy in the management of complications following laparoscopic colorectal surgery [Internet]. Surgeon. 2022; 14(5):287-93. DOI: 10.1016/j.surge.2015.12.003
32. Cuccurullo D, Pirozzi F, Sciuto A, Bracale U, La Barbera C, Galante F, et al. Relaparoscopy for management of postoperative complications following colorectal surgery: ten years experience in a single center [Internet]. Surg Endosc. 2021; 29(7):1795-803. DOI: 10.1007/s00464-014-3862-6
33. Gonzalez García J, Monzón Rodriguez M, Torres Ajá L, Molina Macías D. Caracterización de relaparotomías realizadas en el Hospital Dr. Gustavo Aldereguía Lima 2015-2017 [Internet]. Medisur. 2021 [acceso:14/06/2021]; 19(3):[aprox. -455 p.]. Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/4934
34. Elmore U, Milone M, Parise P, Velotti N, Cossu A, Puccetti F, et al. Relaparoscopy in the management of post-operative complications after minimally invasive gastrectomy for gastric cancer [Internet]. Updates Surg. 2023;75(2):429-434. DOI: 10.1007/s13304-022-01328-z
Published
2024-11-10
How to Cite
1.
Ramos Socarrás AE, Peña Pupo NE, Gallardo Arzuaga RL, Verdecia Acuña F, Quesada Vázquez AJ. Comparison of the results of laparoscopic and open surgery in the reintervention of patients with severe postoperative complications. Rev Cubana Med Milit [Internet]. 2024 Nov. 10 [cited 2025 Jan. 28];53(4):e024075890. Available from: https://revmedmilitar.sld.cu/index.php/mil/article/view/75890
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Clinical Practice Article
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