Prospective Analysis of 40 Initial Laparoscopic Colorectal Resections: A Plea for a Randomized Trial

Abstract

The experience reported herein is on our initial 40 cases of laparoscopic-assisted (LA) colorectal resection that were prospectively evaluated. The operations were performed for colonic tumors of the right segment (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 segmental left colectomies, 5 anterior resections, 2 abdominoperineal resections, and 1 total colectomy. Thirty-one patients (77.5%) had a successfully completed LA resection. The reasons for conversion in the majority of the cases (66.6%) were difficulties in dissection. In the entirely LA procedures, the mean flatus postoperative day was 3, the mean postoperative hospitalization was 10.7 days, and there were 8 complications (25%) in 7 patients. Two patients were reoperated 2 and 3 months later for adhesion and ischemic stenosis of the colon above the anastomosis. There was 1 death in the LA group (3.2%). The length of operative specimen was 19.6 cm, and the mean number of resected lymph node was six. In contrast to laparoscopic biliary surgery, the benefits of LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.

Elective laparoscopic-assisted colectomy for diverticular disease

“…However, with greater experience, the operative time eventually becomes comparable to traditional surgery [38]. A fairly steep learning curve, ranging from at least 15 to as many as 60 cases is associated with the procedure [41,42]. Surgeons who perform a high volume of laparoscopic colectomies have lower rates of intra-and postoperative complications [6].…”

High morbidity rate after converted laparoscopic colorectal surgery

“…Colorectal anastomoses were tested during operation by instilling 50-100 ml air into the rectum after pouring warm saline into the pelvis, and all operative doughnuts were inspected to ensure they were complete. ' The data studied, comparing converted and open groups, were: (1) patient age and health status according to the classification of the American Society of Anesthesiologists"; (2) factors influencing intestinal healing (steroid therapy, radiation, cirrhosis or uraemia); (3) operating time; (4) length of postoperative ileus; (5) length of postoperative hospital stay; (6) clinical anastomotic leakage (faecal matter or pus in the drainage discharge, purulent discharge from the anus, intra-abdominal abscess, reoperation for peritonitis; a postoperative water-soluble enema was not administered routinely but only in cases of suspected leakage); (7) wound infection; (8) …”

Postoperative Komplikationen nach laparoskopischen kolorektalen Resektionen

“…Es ist jedoch zu beachten, dass mit der Konversion die Morbidität deutlich anstieg. Sie betrug nach Konversion immerhin 25% gegenüber 8% nach laparoskopisch beendeten Operationen [46]. Die Morbidität nach laparoskopischer Sigmaresektion wegen eines Karzinoms liegt in der gleichen Größenord-nung wie nach anderen laparoskopischen kolorektalen Resektionen.…”

“…Bis zu 30% Morbidität sind mit einer großen Schwankungsbreite verbunden, die in erster Linie aus unterschiedlichen Erfassungskriterien resultiert. Die Morbidität ist besonders hoch in den Fällen, in denen die laparoskopische Operation zur offenen konvertiert wurde [46,47].Analysiert wurde der Verlauf von 16/65 Konversionen. Verglichen mit dem Verlauf bei 252 primär offenen Kolonresektionen betrug die Morbidität 50% bei laparoskopischen versus 21% bei offenen Operationen.…”