Hostile Abdomen Index Risk Stratification and Laparoscopic Complications
Open Access
- 1 January 2014
- journal article
- Published by The Society of Laparoscopic and Robotic Surgeons in JSLS : Journal of the Society of Laparoendoscopic Surgeons
- Vol. 18 (1), 14-19
- https://doi.org/10.4293/108680813x13693422518993
Abstract
Common life-threatening complications associated with laparoscopy, including bleeding and inadvertent enterotomy, are described in the literature. We investigated the application of the Hostile Abdomen Index related to these complications. We hypothesize that the preoperative score may guide a surgeon in risk stratification. We used data from Monmouth Medical Center morbidity and mortality conferences and reviewed bleeding and enterotomy complications in laparoscopic abdominal surgery. Complications were tracked using the Hostile Abdomen Index compared between 2 periods: published early experience with laparoscopic surgery (1998–2003) and unpublished late experience (2004–2010). The index ascribes a number (1–4) before a laparoscope is inserted and another number (1–4) after the laparoscope is inserted into the abdomen. From 1998 to 2010, 43 patients had bleeding complications (0.45%) and 28 had inadvertent enterotomies (0.29%). There was no difference in bleeding between the early and late experiences. Enterotomy complications decreased in the late experience (P < .001). Our rescue success was 97.2% over 13 years. Those laparoscopic cases with high preoperative scores (3–4) had a higher rate of conversion to open procedures. The Hostile Abdomen Index can be used to track 2 potentially life-threatening laparoscopic complications. The index score has been explained to our surgeons on numerous occasions. A higher chance of bleeding and enterotomy or risk stratification correlates with a preoperative 3 or 4 score and may lead to a more cautious approach toward initial laparotomy or earlier conversion.Keywords
This publication has 12 references indexed in Scilit:
- Laparoscopic vs open resection for rectal cancer: a meta‐analysis of randomized clinical trialsColorectal Disease, 2012
- Laparoscopic entry techniquesPublished by Wiley ,2012
- Improved Short-term Outcomes of Laparoscopic Versus Open Resection for Colon and Rectal Cancer in an Area Health ServiceDiseases of the Colon & Rectum, 2012
- Laparoscopic versus conventional appendectomy - a meta-analysis of randomized controlled trialsBMC Gastroenterology, 2010
- Validation of laparoscopic surgical skills training outside the operating room: a long roadSurgical Endoscopy, 2009
- Enterotomy and Mortality Rates of Laparoscopic Incisional and Ventral Hernia Repair: a Review of the Literature2008
- Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery2007
- Determinants of Long-Term Survival After Major Surgery and the Adverse Effect of Postoperative ComplicationsAnnals of Surgery, 2005
- Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trialThe Lancet Oncology, 2005
- Bleeding remains a major complication during laparoscopic surgery: analysis of the SALTS databaseLangenbecks Archives Of Surgery, 2005