Implementation of laparoscopic colorectal surgery in a rural canadian setting: results of an audit of 233 patients

Background: Laparoscopic colorectal surgery is associated with improved outcomes compared with open procedures; however, its accessibility remains limited in rural Canada. We aimed to evaluate the implementation of laparoscopic colorectal surgery in a rural Canadian hospital. Materials and Methods: We conducted a retrospective cohort study of adult patients who underwent laparoscopic colorectal resection between January 2016 and January 2022 at Le Royer Hospital in Quebec. The primary outcome was the rate of anastomotic leak (AL). Secondary outcomes included perioperative variables, complications, length of hospital stay, 30-day readmission, and mortality rates. Results: A total of 233 patients were included [57.1% male, mean age 65.2 years, mean body mass index (BMI) 27.8 kg/m 2 ]. Nearly half of the patients had an ASA score of 2. Most surgeries were elective (89.7%). Right hemicolectomy (43.8%) and anterior resection (39.1%) were the most common procedures performed. Conversion to open surgery occurred in 6.9% of cases. The median hospital stay was 5 days (range, 3.0–7.00). The perioperative mortality was 0.9%. AL occurred in 13 patients (5.6%), primarily managed by laparoscopic diverting ileostomy. The overall complication rate was 37.3%, with ileus being the most common complication (9.9%). Elevated C-reactive protein levels on postoperative day 3 were associated with AL ( P = 0.0054). Conclusion: To our knowledge, this is one of the largest rural series of laparoscopic colorectal surgeries performed at a single site. This practice appears safe and effective, with outcomes comparable to those of larger centers. Broader adoption, enhanced recovery protocols, and emerging technologies such as fluorescence may further improve the quality of care.