Aim

Colorectal surgery is associated with a high risk of adhesion formation and subsequent complications. Laparoscopic colorectal surgery reduces adhesion formation by 50%, however the effect on adhesion-related complications is still unknown. This study aims to compare differences in incidence rates of adhesion-related readmissions after laparoscopic and open colorectal surgery.

Method

Population data from the Scottish National Health Service were used to identify patients who underwent colorectal surgery between June 2009 and June 2011. Readmissions were registered until December 2017 andcategorized as being either directly or possibly related to adhesions, or as reoperations potentially complicated by adhesions. The primary outcome measure was the difference in incidence ofdirectly adhesion-related readmissions between the open and laparoscopic cohort.

Results

Colorectal surgery was performed in 16 524 patients;4 455 (27%) underwent laparoscopic surgery. Patients undergoing laparoscopic surgery were readmitted less frequently for directly adhesion-related complications, 2.4% (95% CI 2.0 - 2.8%) vs. 7.5% (95% CI 7.1 - 7.9%) in the open cohort. Readmissions for possibly adhesion-related complications were less frequent in the laparoscopic cohort, 16.8% (95% CI 15.6 - 18.0%) vs. 21.7% (95% CI 20.9 - 22.5%), as well as reoperations potentially complicated by adhesions, 9.7% (95% CI 8.9 - 10.5%) vs. 16.9% (95% CI 16.3 - 17.5%).

Conclusion

Overall, any adhesion-related readmissions occurred in over one in three patients after open colorectal surgery and one in four afterlaparoscopic colorectal surgery. Compared with open surgery incidence rates of adhesion-related complications decrease but remain substantial after laparoscopic surgery.