Safety and feasibility of laparoscopic sigmoid colon and rectal cancer surgery in patients with previous vertical abdominal laparotomy

Haksal, Mustafa; Özdenkaya, Yaşar; Atici, Ali Emre; Okkabaz, Nuri; Aksakal, Nihat; Erdemır, Ayhan; Civil, Osman; Öncel, Mustafa

doi:10.1016/j.ijsu.2015.07.687

Cited by 5 publications

(5 citation statements)

References 22 publications

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“…In our institution we tend to follow an enhanced recovery programme, which allows patients to commence oral liquids immediately postoperatively and begin feeding from day 1 . Patient‐controlled analgesia was used as the preferred method of pain relief and was stopped at an average of 2.3 days following surgery. The mean time to the commencement of stoma function was 1.8 days.…”

Section: Resultsmentioning

confidence: 99%

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Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

et al. 2016

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Aim Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy. This paper describes the technique, which is combined with an abdominal approach using a single-incision platform (SIP).Method Data were collected prospectively for consecutive operations between May 2013 and October 2015, including all cases of restorative proctocolectomy with ileoanal pouch anastomosis performed laparoscopically. Only patients having a transanal total mesorectal excision (TaTME) assisted by SIP were included. The indication for RPC was ulcerative colitis (UC) refractory to medical treatment. ResultsThe procedure was performed on 16 patients with a median age of 46 (26-70) years. The male:female ratio was 5:3 and the median hospital stay was 6 (3-20) days. The median operation time was 247 (185-470) min and the overall conversion rate to open surgery was 18.7%. The 30-day surgical complication rate was 37.5% (Clavien-Dindo 1 in four patients, 2 in one patient and 3 in one patient). One patient developed anastomotic leakage 2 weeks postoperatively.Conclusion This initial study has demonstrated the feasibility and safety of TaTME combined with SIP when performing RPC with ileal pouch-anal anastomosis for UC.Keywords Ulcerative colitis, RPC, laparoscopy, single incision laparoscopic surgery, IBD, IPAA What does this paper add to the literature? The paper reports the novel approach of combining single-incision surgery and transanal rectal excision for restorative proctocolectomy. The technique has the ability to minimize surgical trauma and allow safe distal rectal dissection, especially in men with a narrow pelvis.

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Section: Resultsmentioning

confidence: 99%

“…Laparoscopic surgery is now the preferred surgical technique for most patients with colon cancer . Several studies have shown that laparoscopic pelvic dissection in rectal cancer is safe .…”

Section: Introductionmentioning

confidence: 99%

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

et al. 2016

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“…Nevertheless, the number of conversions to open surgery is slightly higher compared to the published literature [26]. This was due to the fact that previous abdominal surgery was not considered a general contraindication for laparoscopic access [27], [28]. Furthermore, the series included elective cases as well as emergency cases.…”

Section: Discussionmentioning

confidence: 99%

The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

Schneider

Brockhaus

Gelos

et al. 2018

Innovative Surgical Sciences

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Background:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

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“…One recent study by Haksal et al evaluated outcomes of laparoscopic sigmoid and rectal resections in 252 patients with no prior abdominal surgery (NPAS) and 25 patients with PAS via prior vertical laparotomy with no significant differences in OR time, conversion rates (7.9 vs. 16%), or any other postoperative outcomes. 77 Besides the small size of the PAS cohort, the study did not distinguish between types of PAS.…”

Section: Reoperative Minimally Invasive Surgery For Colorectal Resectmentioning

confidence: 98%

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

Feigel

Sylla

2016

Clinics in Colon and Rectal Surgery

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Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits.

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Safety and feasibility of laparoscopic sigmoid colon and rectal cancer surgery in patients with previous vertical abdominal laparotomy

Abstract: The presence of a previous laparotomy does not worsen the outcomes in patients undergoing laparoscopic removal of sigmoid or rectal cancer, thus laparoscopy may be considered to be safe and feasible in these cases.

Cited by 5 publications

References 22 publications

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

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