Re: JSLS. 2006;10:169–175 The Influence of Prior Abdominal Operations on Conversion and Complication in Laparoscopic Colorectal Surgery

We read Franko et al’s paper (Franko J, O’Connel BG, Mehall JR, Harper SG, Nejman JH, Zelbey M, Fassler SA. The influence of prior abdominal operations on conversion and complication rates in laparoscopic colorectal surgery. JSLS. 2006;10:169–175) with interest and believe it represents an important body of work. However, we have a couple of comments regarding their analysis and findings. The authors found that the patients who had previous abdominal surgery had a higher rate of conversion compared with patients who had not had any previous abdominal surgery. In this situation, however, it would be important to adjust for other confounding factors that could potentially influence conversion rates. Factors such as the underlying diagnosis (benign vs. malignant), the patient’s body mass index, and the type of surgical resection (rightvs. left-sided and colonic vs. rectal) have been associated with higher conversion rates in laparoscopic colorectal surgery. Furthermore, factors found to be associated with laparoscopic conversion in institutional patient cohorts may not be necessarily applicable to other patient populations. Case in point being that several institutional models are described in the literature1,2 that were developed to predict laparoscopic conversion in colorectal surgery. Yet, when factors from these models were applied to an independent patient cohort, they were not as reliable in predicting conversion as they were in the original cohort.3 This suggests that in addition to patient and disease factors, there can be other unique institutional factors that can potentially contribute to conversion rates, making the generalized applicability of these factors and models questionable.