Modification of laparoscopic rectal surgery

Aim: To investigate the efficacy of laparoscopic rectal surgery for middle and lower rectal cancer in our institution.
Patients and methods: Eighty-four patients (40 with middle and 44 with lower rectal cancer) have undergone laparoscopic low anterior resection since first use of this procedure in our institution in 1998. Total mesorectal excision was performed for all patients basically, with anal preservation attempted except in cases of lower extended advanced rectal cancer. The distal rectum was divided using three different methods with a conventional linear stapler (TA) for open surgery: 1) under pnuemoperitoneum, 2) following eversion of the distal rectum, or 3) using the peranal hand-sawn method. The first 21 cases of rectal divisions used ENDOGIA instead of TA. Operative variables and short-term outcome were compared among procedures.
Results: Four open conversions were required, three of which were related to distal rectal division. All 4 open conversions occurred in the initial 21 cases in which the ENDOGIA was used. Excluding the cases of conversion, low anterior resection (LAR) was performed in 68, abdomino-perineal resection (APR) in 9, and Hartmannfs operation in 3 cases. Operative time and estimated blood loss were 227 min/126 g in LAR and 246 min/288 g in APR. Anastomotic leakage occurred in 8 of 64 LAR cases (12.5%), but no fatal complications or operative deaths occurred.
Conclusion: Laparoscopic rectal surgery was feasible using the various modified version.

Session: Poster

Program Number: P115