Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques

Overbey, Douglas M.; Cowan, Michelle L.; Hosokawa, Patrick; Chapman, Brandon C.; Vogel, Jon D.

doi:10.1007/s00464-017-5422-3

Cited by 8 publications

(4 citation statements)

References 36 publications

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“…Patients operated by surgical teams with a greater experience in laparoscopic colorectal surgery had a generally shorter duration of postoperative ileus [59] [ 52]. Finally, two studies analyzed surgical technique: Firstly, the study of Overbey et al found that hand-assisted laparoscopic technique was associated with a higher incidence of PPOI compared to laparoscopy alone in obese patients (OR 1.33, 95% CI 1.12-1.57) [60]. Secondly, Aydin et al reported that PPOI was significantly more frequent in patients who underwent Hartmann's reversal compared to those who underwent primary resection and anastomosis (p \ 0.01) [61] Five studies examined analgesia as a potential risk factor for PPOI.…”

Section: Systematic Review Of Risk Factors For Ppoimentioning

confidence: 99%

Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta‐analysis

et al. 2020

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Background Prolonged postoperative ileus (PPOI) represents a frequent complication following colorectal surgery, affecting approximately 10-15% of these patients. The objective of this study was to evaluate the perioperative risk factors for PPOI development in colorectal surgery. Methods The present systematic review and meta-analysis was conducted in accordance with the PRISMA Statement. PubMed, EMBASE, SciELO, and LILACS databases were searched, without language or time restrictions, from inception until December 2018. The keywords used were: Ileus, colon, colorectal, sigmoid, rectal, postoperative, postoperatory, surgery, risk, factors. The Newcastle-Ottawa scale and the Jadad scale were used for bias assessment, while the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. Results Of the 64 studies included, 42 were evaluated in the meta-analysis, comprising 29,736 patients (51.84% males; mean age 62 years), of whom 2844 (9.56%) developed PPOI. Significant risk factors for PPOI development were: male sex (OR 1.43; 95% CI 1.25-1.63), age (MD 3.17; 95% CI 1.63-4.71), cardiac comorbidities (OR 1.54; 95% CI 1.19-2.00), previous abdominal surgery (OR 1.44; 95% CI 1.19, 1.75), laparotomy (OR 2.47; 95% CI 1.77-3.44), and ostomy creation (OR 1.44; 95% CI 1.04-1.98). Included studies evidenced a moderate heterogeneity. The quality of evidence was regarded as very low-moderate according to the GRADE approach. Conclusions Multiple factors, including demographic characteristics, past medical history, and surgical approach, may increase the risk of developing PPOI in colorectal surgery patients. The awareness of these will allow a more accurate assessment of PPOI risk in order to take measures to decrease its impact on this population.

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Section: Systematic Review Of Risk Factors For Ppoimentioning

confidence: 99%

Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta‐analysis

et al. 2020

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“…Therefore we strongly comply with the opinion that technical proficiency occurs after approximately 100 cases for HALS [21], which is hardly achievable in rural hospitals and more challenging with LC approach. HALS should be considered not only as bridge procedure, but as best alternative to LC for complicated cases, when difficult rectal dissection (lower or middle part) or colonic mobilization experienced, especially in morbid obese patients with body mass index of 40 or more [6,22,23]. We documented 4 cases of conversion (we defined conversion as lengthening of the incision of that planned at the beginning of procedure) due massive adhesions and one because of bleeding from mesenteric vessels due to non functioning suturing device.…”

Section: Discussionmentioning

confidence: 99%

“…Тем не менее, мы строго придерживаемся мнения о том, что должный опыт хирург получает после примерно 100 операций с использованием HALS [21], что вряд ли возможно в районных больницах и ещё более сложно при использовании стандартного лапароскопического подхода. HALS нужно рассматривать не только как промежуточный этап в освоении лапароскопических технологий, но и как лучшую альтернативу традиционной лапароскопии при сложных случаях, когда возникают трудности при мобилизации среднеи нижне-ампулярного отдела прямой кишки, либо при мобилизации левого изгиба ободочной кишки у тучных пациентов, с индексом массы тела, превышающим 40 [6,22,23]. Нами было задокументировано 4 случая конверсии доступа (конверсией мы называли случаи, когда происходило расширение лапаротомной раны более запланированного) при выраженном спаечном процессе, а также из-за кровотечения из сосудов брыжейки, возникшего из-за поломки сшивающего аппарата.…”

Section: Discussionunclassified

Hand-Assisted Laparoscopic Surgery for the Cancer of the Left Colon and Rectum - An Ideal Option of Minimally Invasive Surgery? Single Centre Experience With 459 Cases

et al. 2017

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BACKGROUND/OBJECTIVE. Hand-assisted laparoscopic surgery (HALS) has been introduced into clinical practice almost three decades ago, very soon after the introduction of conventional laparoscopic surgery. It combines the advantages of both laparoscopic (minimally invasive) and open surgery. Despite a good piece of data in the medical literature, the clear place of this kind of laparoscopic surgery today is not easy to delineate. Our study aimed to review single centre experience in treating patients with left colon and rectal cancers using HALS. METHODS. This study was a retrospective analysis of prospectively collected data of 459 patients undergoing hand assisted laparoscopic colorectal surgery for left colon and rectal cancer, in a single tertiary care institution, National Cancer Institute, from January 1, 2006, to December 31, 2016. All consented patient with confirmed invasive cancer of left colon and rectum undergoing HALS were included in the analysis. RESULTS. The patients’ mean age was 64.14±9.75 years. Female and male ratio was similar: 232 (50,5 %) versus 227 (49,5 %). The mean length of postoperative hospital stay was 6.7 (from 2 to 34) days. There were 5 (1,1 %) conversions to open surgery. Histological examination revealed mean lymph node harvest to be 15 ± 12, ranging from 8 to 90. Stage I, II and III cancer was similar in distribution accounting for 133 (28,9%), 139 (30,3 %), 151 (32,9 %) patients respectively and 36 (7,8 %)patients with stage IV. 244 (53,2) of patients underwent surgery for the cancer of the left colon (sigmoid colectomy or left hemicolectomy), and 215 (46,8 %) patients underwent surgery for rectal cancer. Postoperative complications occurred in 28 (6.1 %) patients, eight of them (1,7 %) needed reintervention (laparotomy) because of anastomotic insufficiency and intraabdominal abscesses. Two (0,4 %) patients died during 30 day postoperative period. CONCLUSION. In our experience, HALS was very reliable andfeasible minimally invasive surgical technique for the cancers of left colon and rectum, related with short learning curve and excellent oncological clearance, short operating time and low number of postoperative complications. It may be used as a standard approachfor this type of pathology, or as a safe bridge from open to conventional laparoscopic surgery.

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“…Ряд авторов указывает на прогностическую роль таких факторов, как проведение неоадъювантной химиолучевой терапии, высокий уровень перевязки нижней брыжеечной артерии (НБА), пол пациента, наличие обширных спаек в малом тазу, возраст пациента, избыточную массу тела в увеличении риска возникновения послеоперационных осложнений [5,6,7,13,15]. Однако данные целого рядя работ противоречат тем, которые приведены выше [8][9][10].…”

Section: Introductionunclassified

Predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction

Куликов

Александрович

Веркин

et al. 2023

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хирургическая гастроэнтерология surgical gastroenterologyРезюме Цель исследования: оценка значимости ряда клинических предикторов осложненного течения периоперационного периода у пациентов с раком прямой кишки и ректосигмоидного перехода.Материалы и методы. Ретроспективный анализ 170 больных раком прямой кишки или ректосигмоидного соединения. В исследование включались пациенты с аденокарциномой прямой кишки или ректосигмоидного перехода, которым выполнялось хирургическое вмешательство в сочетании с частичной или тотальной мезоректумэктомией. Во всех случаях формировался анастомоз. Мужчин оказалось 54,7%, женщин 45,3%. Средний возраст пациентов составил 63 года. Предоперационное лечение было проведено 54 пациентам. Оценивалось влияние различных факторов (пол, возраст, ИМТ, наличие анатомических факторов риска, проведение неоадъювантной терапии, тип операции, уровень перевязки нижней брыжеечной артерии, проведение вынужденной мобилизации селезеночного изгиба толстой кишки, хирургический доступ, тип анастомоза, наличие защиты анастомоза, продолжительность операции, наличие превентивной стомы) на риск развития периоперационных осложнений и, отдельно, несостоятельности шва анастомоза.Результаты. Неоадъювантная химиолучевая терапия повышает риск развития интраоперационных осложнений в 3,4 раза. Риск возникновения несостоятельности анастомоза увеличен у мужчин в 3,35 раза, при вынужденной мобилизации селезеночного изгиба толстой кишки в 2,6 раза и при интраоперационной перфорации толстой кишки в 10 раз. Предикторами осложненного течения послеоперационного периода являются: спаечный процесс, узкий таз, короткая брыжейка сигмовидной кишки, долихосигма (р<0,05).Заключение. Наличие вышеописанных факторов риска должно приводить к применению мер по профилактике и устранению последствий периоперационных осложнений Ключевые слова: рак прямой кишки, предикторы, осложнения Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.

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Laparoscopic colectomy in obese patients: a comparison of laparoscopic and hand-assisted laparoscopic techniques

Cited by 8 publications

References 36 publications

Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta‐analysis

Risk Factors for Prolonged Postoperative Ileus in Colorectal Surgery: A Systematic Review and Meta‐analysis

Hand-Assisted Laparoscopic Surgery for the Cancer of the Left Colon and Rectum - An Ideal Option of Minimally Invasive Surgery? Single Centre Experience With 459 Cases

Predictors of complicated course of perioperative period in patients with rectal cancer and rectosigmoid junction

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