Laparoscopic Assisted Colorectal Surgery

Abstract

Forty-nine consecutive patients underwent laparoscopic assisted colorectal surgery for benign and malignant lesions of the colon. Thirty-eight of the 49 operations (78%) were completed successfully with laparoscopic assistance. A large tumor bulk or dense adhesions were the most common reasons for conversion to laparotomy. Twenty-eight of the 38 patients (74%) in the laparoscopically completed group were tolerating a diet by postoperative day 2, and 31 (82%) passed flatus or a bowel movement by the third postoperative day. The mean postoperative hospital stay for this group was 4.8 days, which compared very favorably to that reported in the literature for traditional open colorectal operations. Twelve patients developed complications, for a 24% morbidity in the series. However, only 3 (6%) of these complications were related to the laparoscopic part of the procedure. Inspection of the pathologic specimens revealed adequate margins and a lymph node harvest that averaged 11 nodes per specimen. We concluded that laparoscopic assisted colorectal surgery is a safe and feasible technique, which may be associated with a faster return of bowel activity and a shorter hospital stay. Although the extent of resection appears comparable to that of laparotomy, it is too early to assess long-term outcome when it is applied in the treatment of malignancy.

Factors Affecting Early Postoperative Feeding Following Elective Open Colon Resection

“…More significantly, this hospital stay is shorter than that reported in more than 540 patients in multiple laparoscopic colectomy trials, in which the mean hospital stay was 6.7 days (range, 4.0-12.3 days). 1,6 Although the results of our study were good, 13.5% of our patients were still unable to tolerate early postoperative feeding after elective open colon resection. In our study, we attempted to elicit the risk factors that might predispose patients to fail early postoperative feeding following open colon resection.…”

“…However, recent clinical trials of patients undergoing laparoscopic or laparoscopic-assisted colectomy, with feeding initiated by protocol rather than by objective signs of return of bowel function, resultedinearlierfeedingandshortenedhospital stay. [1][2][3] These advantages initially were believed to be unique to laparoscopic colectomy, owing to smaller incisions and less manipulation of the gastrointestinal tract.…”

Laparoscopic colectomy for colon cancer: Trial update

“…It is presumed that laparoscopic-specific complications are likely to be more common early rather than late in the learning curve experience. In general, rates of morbidity and mortality are very comparable to those reported for open surgery for at least short-term perioperative complications [1,4,6,9,10,20,30,[32][33][34][35][36][37][38].…”

Laparoscopic surgery for cancer patients

“…135,136 The adequacy of lymphadenectomy has been addressed by several studies, which consistently showed that the number of lymph nodes resected laparoscopically was similar to the number retrieved in open colectomy for cancer. 112,115,116,120,126,128,131 The technique of laparoscopic colon resection also has been controversial. Some surgeons have performed completely laparoscopic colon resections as opposed to laparoscopic-assisted resections.…”

“…Relative indications for converting to an open procedure include tumor invasion into small bowel, adhesions, fistulas, obesity, bulky tumor, bleeding, and thickened or short mesentery. 112,114,115,120,121,124,126,127,129 It is important to identify the need to convert to an open procedure as soon as possible because this can reduce operative time and overall costs, both of which are significantly increased when conversion to an open technique is required.…”