Laparoscopic Colorectal Surgery in Urgent and Emergent Settings

Abstract

Laparoscopic colectomy (LC) is slowly becoming the standard of care for elective resections. The use of LC in the emergency setting is relatively unstudied. Authors describe their experience with a series of 34 emergent and urgent LC cases for a variety of benign and neoplastic colorectal diseases, admitted from 2007 to 2009 at Emergency Department of a tertiary level hospital, comparing laparoscopic group with matched control open group. Twenty-one LC was performed for benign complicated disease, 12 for malignant disease and 1 for iatrogenic perforation during colonoscopy. Two cases were converted to open procedure (5.8%), the average operative time was 188 minutes (SD 61.84). The average postoperative length of hospital stay was 6.57 days (SD 1.75), with no postoperative mortality and no major morbidity. Results of laparoscopic group compared with 61 patients treated with open colorectal procedure confirm the advantages of laparoscopic approach similar to those established in elective colorectal surgery. With increasing experience, LC would be a feasible and an effective option in nonelective situations lowering complication rate and length of hospital stay.

Systematic review of emergency laparoscopic colorectal resection

“…). These studies comprised 11 case series and 11 comparative studies comparing emergency LS versus OS. No randomized clinical trials were identified.…”

Emergent Laparoscopic Colectomy Is an Effective Alternative to Open Resection for Benign and Malignant Diseases: a Meta-Analysis

“…The bibliographic search identified 389 potentially relevant studies, and subsequent title and abstract screening eliminated 371 studies that obviously did not fit our inclusion criteria. Out of the remaining 18 studies, 11 studies [4,[8][9][10][11][12][13][14][15][16][17] were finally included in our meta-analysis after a full-text review ( Fig. 1).…”

“…Eight studies [4,8,[10][11][12][13][14]17] reported operative time. Pooled data of these eight studies indicated that an open procedure was more time-efficient (random effects model; WMD 36.47 min; 95 % CI 12.07, 60.87; P = 0.003).…”

Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges

“…PUD-related deaths arise primarily from hemorrhage and perforation, both of which can be managed with minimally invasive surgery (MIS). The evidence-based guidelines produced by the European Association for Endoscopic Surgery in 2006 and many others studies have demonstrated the superiority of laparoscopic surgery, even in the emergency setting (6,7). Furthermore, routine use of laparoscopy in the diagnosis and management of the acute abdomen has been widely accepted (8).…”