Laparoscopic Total Colectomy. Feasibility and Results

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.

Session: Poster
Program Number: P130
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