Laparoscopic resection for colorectal diseases: short-term outcomes of a single center

Abstract

Laparoscopic resection for colorectal diseases: short-term outcomes of a single center INTRODUCTIONLaparoscopic colorectal surgery provides less postoperative pain, better cosmesis, shorter hospital stay and earlier patient mobilization (1, 2). Jacobs et al. (3) performed the first laparoscopic colon resection in 1991 (3). However, it took time to be adopted due to its technical difficulties, lack of clinical evidence, the learning curve and fear of tumor seeding (4, 5). The recently published case series proved that there was no significant difference between open and laparoscopic colorectal surgery in terms of tumor recurrence, distant metastasis rates and disease free survival (6-8). Although laparoscopy is still not the gold standard in colorectal surgery, its advantages in experienced hands are acknowledged (9). In our study, we presented 33 cases who underwent laparoscopic colorectal resection for benign or malignant diseases. MATERIAL AND METHODSThirty-three patients underwent laparoscopic colorectal surgery between January 2013-September 2014. An ethics committee approval was obtained from Marmara University. Our prospective database consisted of information on patient demographics, pathology reports (TNM stage, number of dissected lymph nodes), operation type, complications and length of hospital stay.All the patients were evaluated for presence of locoregional disease and distant metastasis with colonoscopy, computed thoracic and abdominal tomography and/or pelvic magnetic resonance imaging. Patients were informed on laparoscopic surgery and their consents were obtained. Locally advanced rectal cancers were treated with neoadjuvant chemotherapy and radiation therapy. Preoperative bowel preparation was achieved by sodium phosphate containing purgatives, and the antibiotic prophylaxis consisted of 2 gr Cefazolin and 500 mg Metronidazole. A second antibiotic dose was administered in operations lasting longer than 4 hours. Low molecular weight heparins were applied for thrombo-emboli prophylaxis with a dose adjusted for body weight 12 hours before the operation.Under general anesthesia, a 1 cm supra-umbilical skin incision was done followed by Veress needle insertion for carbon dioxide insufflation up to 10-12 millimeter mercury (mmHg). Mesocolic excision was performed for colon tumors and total mesorectal excision was performed for rectal cancers. To avoid seeding and surgical site infection, a wound protector was used in all operations (Alexis® O™ Retrac- 199Objective: Even though, laparoscopy is not accepted as the current gold standard in colorectal surgery, it can be performed as safely as open surgery. It is also widely accepted that the technique has many advantages. In this study, we evaluated the results of 33 patients with laparoscopic colorectal resection. Material and Methods:Thirty-three patients who underwent laparoscopic colon surgery between January 2013 and September 2014 in the General Surgery Clinic at Marmara University Hospital were included in the study. Patients were evaluated in te...

Our Experience of Laparoscopic Colorectal Surgery: Short Term Outcomes

“…6,7 Ancak açık cerrahiye göre birçok avantajı mevcut olup bunların başında kozmetik görünüm, erken derlenme, postoperatif dönemde daha az ağrı olması, yara yeri enfeksiyonunun daha az olması ve insizyonel herni oranının daha az olması gibi faktörler gelmektedir. 8,9 Malignite olgularına bakıldığında sağ kalım için günümüzde kabul edilen en önemli kriterlerin başında diseke edilen lenf nodu sayısının yeterli olması, piyes sınırlarının ve radyal sınırların tümörden temizlenmiş olması gelmektedir.…”

“…Attaallah ve ark. 7 yaptıkları çalışmada ise 33 hastada ortalama hastanede yatış süresini 5 gün olarak saptamışlardır. Bizim ortalamamızı arttıran sebeplerden birisinin 3 adet majör komplikasyonlu hastamızın olduğunu düşünmekteyiz.…”

Learning Curve at Laparoscopic Colorectal Surgery

“…Advanced laparoscopic surgery has been used safely in many procedures recently but it is still not considered as the gold standard in colorectal surgery. 6,7 One of the probable reasons for this is the fact that the learning curve is long and steep. 5 The laparoscopic colorectal surgery, which is known to have more advantages than open surgery, provides significant benefit in obese, high ASA score and old patients.…”

Short-term outcomes of a single center: Laparoscopic resection of colorectal diseases

“…Laparoscopy is being widely used in the treatment of both malign and benign colorectal diseases in many surgical centers where were advanced in laparoscopic procedures. [7,12,13] Previous research has demonstrated its advantages when compared with open surgery, such as short hospital stay, greater satisfaction with incision cosmesis, oncological equivalence, postoperative recovery time, and cost effectiveness. [9,[13][14][15][16] The complication rate of laparoscopic colorectal procedures were reported as 1.5-36% and is not higher than open surgery.…”

“…[7,12,13] Previous research has demonstrated its advantages when compared with open surgery, such as short hospital stay, greater satisfaction with incision cosmesis, oncological equivalence, postoperative recovery time, and cost effectiveness. [9,[13][14][15][16] The complication rate of laparoscopic colorectal procedures were reported as 1.5-36% and is not higher than open surgery. [2,17] Our complication rate was 21.4% and the most common complication in our series was anastomotic leakage (AL) (7.1%).…”