The impact of conversion on the risk of major complication following laparoscopic colonic surgery. An international, multicentre prospective audit

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van der Pool Anne, Rawlings Alexandra, Sánchez-Guillén Luis, Kuiper Sara, Negoi Ionut, Buchs Nicolas, El-Hussuna Alaa, Battersby Nick J., Buchs Nicolas C., Buskens Christianne, Chaudri Sanjay, Frasson Matteo, Gallo Gaetano, Minaya-Bravo Ana María, Morton Dion, Nepogodiev Dmitri, Pata Francesco, Singh Baljit, Zmora Oded, Perry Rita, Magill Laura, Altomare Donato, Bemelman Willem, Brown Steven, Denost Christianne Buskens Quentin, Knowles Charles, Laurberg Søren, Lefevre Jérémie H., Möeslein Gabriela, Pinkney Tom, Vaizey Carolynne, Bilali S., Bilali V., Salomon M., Cillo M., Estefania D., Patron Uriburu J., Ruiz H., Farina P., Carballo F., Guckenheimer S., Proud D., Brouwer R., Bui A., Nguyen B., Smart P., Warwick A., Theodore J. E., Herbst F., Birsan T., Dauser B., Ghaffari S., Hartig N., Stift A., Argeny S., Unger L., Strouhal R., Heuberger A., Varabei A., Lahodzich N., Makhmudov A., Selniahina L., Feryn T., Leupe T., Maes L., Reynvoet E., Van Langenhove K., Nachtergaele M., Monami B., Francart D., Jehaes C., Markiewicz S., Weerts J., Van Belle K., Bomans B., Cavenaile V., Nijs Y., Vertruyen M., Pletinckx P., Claeys D., Defoort B., Muysoms F., Van Cleven S., Lange C., Vindevoghel K., Wolthuis A., Todorovic M., Dabic S., Kenjic B., Lovric S., Vidovic J., Delibegovic S., Mehmedovic Z., Christiano A., Lombardi B., Marchiori M., Tercioti V., Dardanov D., Petkov P., Simonova L., Yonkov A., Zhivkov E., Maslyankov S., Pavlov V., Sokolov M., Todorov G., Stoyanov V., Batashki I., Iarumov N., Lozev I., Moshev B., Slavchev M., Atanasov B., Belev N., Krstev P., Penkov R., Šantak G., Ćosić J., Previšić A., Vukušić L., Zukanović G., Zelić M., Kršul D., Lekić Vitlov V., Mendrila D., Orhalmi J., Dusek T., Maly O., Paral J., Sotona O., Skrovina M., Bencurik V., Machackova M., Kala Z., Farkašová M., Grolich T., Procházka V., Hoch J., Kocian P., Martinek L., Antos F., Pruchova V., El-Hussuna A., Ceccotti A., Madsbøll T., Straarup D., Uth Ovesen A., Christensen P., Bondeven P., Edling P., Elfeki H., Alexandrovich Gameza V., Michelsen Bach S., Zheltiakova I., Krarup P. M., Krogh A., Rolff H. -C., Lykke J., Juvik A. F., Lóven H. H. K., Marckmann M., Osterkamp J. T. F., Madsen A. H., Worsøe J., Ugianskis A., Kjær M. D., Youn Cho Lee B., Khalid A., Kristensen M. H., El Sorogy M., Elgeidie A., Elhemaly M., El Nakeeb A., Elrefai M., Shalaby M., Emile S., Omar W., Sakr A., Thabet W., Awny S., Metwally I., Refky B., Shams N., Zuhdy M., Lepistö A., Keränen I., Kivelä A., Lehtonen T., Siironen P., Rautio T., Ahonen-Siirtola M., Klintrup K., Paarnio K., Takala H., Hyöty M., Haukijärvi E., Kotaluoto S. -M., Lehto K., Tomminen T., Huhtinen H., Carpelan A., Karvonen J., Rantala A., Varpe P., Cotte E., Francois Y., Glehen O., Passot G., D'Alessandro A., Chouillard E., Etienne J. C., Ghilles E., Vinson-Bonnet B., Germain A., Ayav A., Bresler L., Chevalier R., Denost Q., Didailler R., Rullier E., Tiret E., Chafai N., Lefevre J. H., Parc Y., Sielezneff I., Mege D., Lakkis Z., Barussaud M., Krones C., Bock B., Webler R., Baral J., Lang T., Münch S., Pullig F., Schön M., Hinz S., Becker T., Möller T., Richter F., Schafmayer C., Hardt J., Kienle P., Crescenti F., Ahmad M., Soleiman Y., Papaconstantinou I., Gklavas A., Nastos K., Theodosopoulos T., Vezakis A., Stamou K., Saridaki A., Xynos E., Paraskakis S., Zervakis N., Skroubis G., Amanatidis T., Germanos S., Maroulis I., Papadopoulos G., Dimitriou N., Alexandrou A., Felekouras E., Griniatsos J., Karavokyros I., Papadopoulos A., Chouliaras C., Ioannidis P., Katsounis D., Kefalou E., Katsoulis I. E., Balalis D., Korkolis D. P., Manatakis D., Tzovaras G., Baloyiannis I., Mamaloudis I., Lázár G.,
ISSN: 1462-8910

Background: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. Methods: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. Results: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P 

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