Laparoscopic total colectomy: Does the indication influence the outcome?

Abstract

AIM:To assess and compare outcomes of laparoscopic total colectomy performed for a variety of indications. METHODS:Sixty six patients underwent laparoscopic total colectomy for inflammatory bowel disease (IBD) (13) and other diseases (53). Data on demographics, pre-and post-operative outcomes were collected prospectively. RESULTS:Mean operative time was 4.5 h. Conversion rate was 13.6%. Total colectomy performed for IBD was associated with a significantly higher anastomotic leak rate (23.1% vs 1.9%, P < 0.05). On univariate analysis, hand sewn anastomosis and treatment with more than 20 mg of prednisolone for at least 3 mo was associated with a higher anastomotic leak rate (P < 0.05). No significant difference was found in return of gut function and overall morbidity between disease groups. CONCLUSION:Laparoscopic total colectomy is feasible and outcomes are equivalent whatever the indication, except for anastomotic leak rate which is higher for patients with IBD.

Postoperative pneumoperitoneum after colorectal surgery: Expectantvssurgical management

“…Could these patients be at a higher risk of developing postoperative pneumoperitoneum? No study answers this question directly; however, it has been shown that patients with inflammatory bowel disease are at a higher risk of postoperative complications [15,16] . One of the possible complications is anastomotic leaks, which in turn, has been shown to be a cause of postoperative pneumoperitoneum [1,15,16] .…”

“…No study answers this question directly; however, it has been shown that patients with inflammatory bowel disease are at a higher risk of postoperative complications [15,16] . One of the possible complications is anastomotic leaks, which in turn, has been shown to be a cause of postoperative pneumoperitoneum [1,15,16] . These patients are at a higher risk for leaks due to their immunosuppressed state and overall inflammatory disease process causing tissue friability and dense adhesions [16] .…”

“…However, their study had a small sample size of 109 patients [16] . In 2011, Cotte et al [15] compared inflammatory bowel disease to other indications of total colectomy and found significantly more anastomotic leaks in the former patients. In addition, in patients receiving total colectomy for other indications other than inflammatory bowel disease, such as colon cancer, slow transit constipation or diverticular disease, the anastomotic leak rate was equivalent to segmental colectomy [15,17] .…”

“…In 2011, Cotte et al [15] compared inflammatory bowel disease to other indications of total colectomy and found significantly more anastomotic leaks in the former patients. In addition, in patients receiving total colectomy for other indications other than inflammatory bowel disease, such as colon cancer, slow transit constipation or diverticular disease, the anastomotic leak rate was equivalent to segmental colectomy [15,17] . Thus, because the rate of leaks between total and segmental colectomy for conditions other than inflammatory bowel disease is similar, it can be inferred that the rate of postoperative pneumoperitoneum is not increased because of the procedure but is related to the underlying disease process.…”

A Novel Rodent Model Modifying Perioperative Temperature and Humidity during Bowel Surgery and Mimicking Laparoscopic Conditions

“…Today minimal invasive bowel resections have been established as a standard procedure in most hospitals. The laparoscopic approach appears to be a safe option in benign and malignant diseases [1][2][3][4], and clinical analyses have even shown an improved outcome of laparoscopic bowel resections with primary intestinal anastomoses compared to open procedures [5].…”