Effect of Previous Abdominal Surgery on Laparoscopic Liver Resection: Analysis of Feasibility and Risk Factors for Conversion

Introduction: Previous abdominal surgery has traditionally been considered an additional element of difficulty to later laparoscopic procedures. The aim of the study is to analyze the effect of previous surgery on the feasibility and safety of laparoscopic liver resection (LLR), and its role as a risk factor for conversion. Materials and Methods: After matching, 349 LLR in patients known for previous abdominal surgery (PS group) were compared with 349 LLR on patients with a virgin abdomen (NPS group). Subgroup analysis included 161 patients with previous upper abdominal surgery (UPS subgroup). Feasibility and safety were evaluated in terms of conversion rate, reasons for conversion and outcomes, and risk factors for conversion assessed via uni/multivariable analysis. Results: Conversion rate was 9.4%, and higher for PS patients compared with NPS patients (13.7% versus 5.1%, P=.021). Difficult adhesiolysis resulted the commonest reason for conversion in PS group (5.7%). However, operative time (P=.840), blood loss (P=.270), transfusion (P=.650), morbidity rate (P=.578), hospital stay (P=.780), and R1 rate (P=.130) were comparable between PS and NPS group. Subgroup analysis confirmed higher conversion rates for UPS patients (23%) compared with both NPS (P=.015) and PS patients (P=.041). Previous surgery emerged as independent risk factor for conversion (P=.033), alongside the postero-superior location and major hepatectomy. Conclusion: LLR are feasible in case of previous surgery and proved to be safe and maintain the benefits of LLR carried out in standard settings. However, a history of surgery should be considered a risk factor for conversion.