Laparoscopic colectomy without mechanical bowel preparation

Zmora, Oded; Lebedyev, Alexander; Hoffman, Aviad; Khaikin, Marat; Munz, Yaron; Shabtai, Moshe; Ayalon, Amram; Rosin, Danny

doi:10.1007/s00384-005-0044-y

Cited by 49 publications

(35 citation statements)

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“…The standard use of MBP has been largely abandoned, because studies have proven that its use does not diminish the risk of anastomotic leakage or wound infections [31][32][33][34][35][36][37][38]. However, the relationship between MBP and working space in laparoscopic surgery is still a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

“…However, several, randomized, controlled trials and metaanalyses have been conducted on MBP before colorectal operations to investigate its influence on anastomotic leakage and septic complications. The vast majority of studies conclude that there is no advantage of MBP before colorectal resections regarding the aforementioned complications [31][32][33][34][35][36][37][38]. The purpose of this study was to investigate in a porcine model whether MBP has a positive influence on working space during laparoscopy.…”

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confidence: 99%

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Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

et al. 2013

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Background Adequate working space is a prerequisite for safe and efficient minimal access surgery. No objective data exist in literature about the effect of mechanical bowel preparation (MBP) on working space in laparoscopic surgery. We objectively measured this effect with computed tomography in a porcine laparoscopy model. Methods Using standardized anesthesia, twelve 20-kg pigs without MBP and eight 20-kg pigs with MBP were studied with computed tomography at intra-abdominal pressure (IAP) levels of 0, 5, 10, and 15 mmHg. Volumes and dimensions of the pneumoperitoneum were measured on reconstructed CT images and compared between the pigs with and those without MBP. Results A reproducible and statistically significant increase of approximately 500 ml in pneumoperitoneum volume was found in the MBP group at all levels of IAP. This represents a 43 % relative increase at a pneumoperitoneum pressure of 5 mmHg, 21 % at IAP 10 mmHg, and 18 % at IAP 15 mmHg. Peak inspiratory pressure was lower at IAP 0 and 5 mmHg in the MBP group. Anteroposterior diameter in the group with MBP was lower at 0 mmHg, but abdominal dimensions were similar in both groups at all other IAPs. This shows that the gain in working space is due to a diminished volume of the intraabdominal content and not to compression or displacement of the bowel. Conclusions MBP increases working space by reducing bowel content. Especially at low intra-abdominal working pressures, the increase in working space associated with MBP could represent an important benefit in challenging laparoscopic surgery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Optimizing working-space in laparoscopy: measuring the effect of mechanical bowel preparation in a porcine model

et al. 2013

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“…In the past decade, our department has adopted a policy of selective mechanical bowel preparation, avoiding its routine use, and for this reason, large portion of the patients in this study had laparoscopic resection of distal colorectal segments without mechanical bowel preparation [10]. Not surprisingly, large portion of the patients who had anasto-motic leak did not have mechanical bowel preparation, reflecting this policy.…”

Section: Discussionmentioning

confidence: 97%

The Laparoscopic Approach in the Treatment of Distal Colorectal Cancer

Lebedyev¹,

Urban²,

Rosin³

et al. 2011

TOCOLCJ

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Purpose: The use of laparoscopic techniques has been widely accepted for most solid organ malignancies, but its use for distal colorectal cancer is still controversial. The aim of this study is to review our experience with laparoscopic resections of distal colorectal cancer and to assess patients' outcome. Methods:A retrospective chart review of prospectively entered data base was made to identify patients who underwent laparoscopic resections of distal colorectal cancer. Data relative to demographics, tumor characteristics, surgical procedure and adjuvant or neoadjuvant treatment were recorded. Long term follow up (survival and recurrence) was established from the patients' charts and telephone interviews.Results: 94 consecutive patients underwent laparoscopic resections due to distal colorectal cancer. Surgery was in curative intent in 89 cases (95%). Conversion rate was 20%. Four patients (4%) died from different septic complications in the early postoperative period. Complete long term follow up follow up was achieved in 71 (75%) patients. There were no port site metastases. Local recurrence was diagnosed in 3 cases (4%). Twenty one patients (30%) died during this period, 11 due to metastatic disease, 1 from pneumonia, 9 patients from other non cancer related reasons. Conclusions:Laparoscopic surgery may be safe and feasible for the treatment of distal colorectal cancer with acceptable long term oncologic results. The complexity of the procedure as well as the level of anastomosis results in relatively high complication rate, which may potentially improve by overcoming the "institutional learning curve". Randomized controlled trials comparing open and laparoscopic surgery for rectal cancer should verify these results, before the laparoscopic approach can be widely recommended.

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“…In the case of patients who did not receive mechanical bowel preparation and had to undergo anastomosis of the left colon using the doublesuture technique, a commercial enema was used before being admitted to the hospital the morning of the surgery or a rectal lavage was performed in the operating room after anaesthesia, depending on the preference of the performing surgeon [20][21][22][23][24].…”

Section: Methodsmentioning

confidence: 99%