Totally laparoscopic or laparoscopic-assisted (LA) right hemicolectomies (RHC) have been reported as acceptable procedures for both benign and malignant colon diseases. Laparoscopic RHC either with a totally intracorporeal or extracorporeal anastomosis has been performed for the treatment of ascending colon diseases including cancer, polyps, chronic inflammatory bowel diseases, AVM. However, research has not been conducted on clinical distinctions of any of two different approaches for constructing anastomosis intracorporeal (IC) or extracorporeal. Based upon a large experience on laparoscopic colon surgery, we designed a nonrandomized prospective study comparing laparoscopic right hemicolectomy with either totally IC anastomosis or LA anastomosis .
A consecutive series of patients requiring laparoscopic RHC for various right colon diseases from April 1991 to March 2007 at the Texas Endosurgery Institute, San Antonio, TX, was prospectively studied. The operative procedures and instrumentation were standardized for all laparoscopic right hemicolectomies with either IC or LA anastomosis.
Since April 1991, 423 (RHC) were attempted laparoscopically following selection criteria for the procedure, and 411 (97.1%) were completed. Among these 411 cases, the procedure for 288 patients (65.7%) received IC, while the remaining 123 patients (27.4%) had LA hemicolectomy with extracorporeal anastomosis.
The mean operative time for laparoscopic colectomies with ICs was 159.6 +/- 27.1 minutes, mean blood loss was 83.3 +/- 14.4 ml, mean length of postoperative hospitalization was 8.7 +/- 8.5 days, and procedure-related intraoperative as well as postoperative morbidity rates are 1.6% and 5.2%, respectively. For LA procedures with extracorporeal anastomosis, the mean operative time was 165.5 +/- 29 minutes, mean blood loss was 135.0 +/- 65.5 ml, mean length of hospital stay was 6.9 +/- 2.8 days, intraoperative complication rate is 4.0%, and postoperative complication rate is 17%.
laparoscopic colectomy either with IC or LA anastomosis can be performed safely and effectively for managing a variety of colonic diseases, including malignant colonic neoplasia with reasonable operation time, hospital stay, as well as very less blood loss. IC anastomosis show shorter operation time, less intraoperative blood loss, lower intraoperative and postoperative complications rates, especially when comorbidities are counted.
Session: Poster of Distinction
Program Number: P003