Alejandro Canelas, MD, Maximiliano Bun, MD, Esteban Grzona, MD, Nicolás Goldaracena, MD, Mariano Laporte, MD, Nicolás Rotholtz, MD. Colorectal Surgery Section. Hospital Alemán. Buenos Aires – Argentina.
INTRODUCTION: Laparoscopic colectomy is a complex procedure. Few center practice laparoscopic total colectomy because the technical difficulty and the need for a long learning curve. The aim of this paper is to assess the feasibility and safety of laparoscopic total colectomy.
METHODS AND PROCEDURES: Observational retrospective research based on a prospective collected database, including all patients who underwent laparoscopic colectomy between July 2000 and June 2010. Rectal resection were excluded. Patients were divided into two groups; G1: total colectomy and G2: segmental colectomy. Univariate analysis was performed analyzing the perioperative variables of the two groups.
RESULTS: 659 procedures were included, G1: 59 (8.9%) and G2: 600 (91.1%). In G1 were 24 (41%) total colectomy with ileorectal anastomosis and 35 (59%) total colectomy with end ileostomy. The indications for surgery in G1 were: 12 (20%) synchronous tumors, 2 (4%) Lynch syndrome, 5 (8%) attenuated familiar adenomatous polyposis, 2 (4%) colonic inertia, 3 (5%) Crohn disease and 35 (59%) ulcerative colitis. 31 (53%) were women. The average age was 41 ± 19 (4-92) years and average body mass index was 22 ± 4 (12-30) kg/m². Nine (15%) patients had previous abdominal surgery.
G1 presented longer operating time (G1: 200 ± 55 minutes vs. G2: 166 ± 64 minutes, p< 0.05). There were no differences in the rate of intraoperative complications and in the conversion rate. G1 presented more postoperative complications (G1: 37.2% vs. G2: 18.6, p < 0.05) but were no differences in major complications (Dindo III, IV and V). No mortality was observed in G1. G1 presented higher hospital stay (G1: 5.1 ± 3.2 days vs. G2: 4 ± 3.8 days. p = 0.03).
CONCLUSION: Laparoscopic total colectomy is feasible and safe.
Program Number: P130