Noam Shussman, MD, Maria Brown, Michael C Johnson, Giovanna da Silva, MD, Steven D Wexner, MD, Eric G Weiss, MD
Cleveland Clinic Florida
INTRODUCTION: Laparoscopic surgery is associated with well-known benefits, one of which is earlier return of bowel function. Hand-assisted laparoscopic surgery (HALS) may allow complex cases to be carried in a minimally invasive manner. The possible shorter operative time with HALS favors earlier return of bowel function, but the longer incision may adversely impact the development of postoperative ileus. The aim of this study was to assess and compare the incidence of postoperative ileus and the need for nasogastric tube decompression in these patients.
METHODS AND PROCEDURES: Following IRB approval, we performed a retrospective chart review of patients who underwent elective left-sided large bowel resections with primary anastomosis between 2009 and 2012. Exclusion criteria were urgent operation, stoma creation, ASA IV classification, and postoperative anastomotic leakage. The patients were divided into three groups: conventional laparoscopic surgery, HALS, or open surgery. We evaluated the incidence of postoperative ileus as measured by the use of nasogastric decompression, the time to first flatus and bowel movement, and the time to solid diet tolerance in each group.
RESULTS: Two hundred fifty-one patients were included in this study. Eighty patients underwent open surgery, 89 patients underwent HALS, and 82 patients underwent conventional laparoscopic surgery. Demographic characteristics were similar in all three groups. The proportions of patients who needed postoperative nasogastric decompression, the duration of such decompression, the time from surgery to first flatus and first bowel movement, the time to tolerance of solid diet, and the total length of stay were all significantly reduced in the laparoscopic and HALS groups compared with the open surgery group. There were no significant differences in any of these measures between the laparoscopic group and the hand-assisted group. The data are summarized in the following table:
| Open | HALS | Laparoscopic | P values | |||
|---|---|---|---|---|---|---|
| Open-HA | Open-Lap | HA-LAP | ||||
| Patients (n) | 80 | 89 | 82 | |||
| NGT patients (n) | 20 | 4 | 4 | |||
| NGT patients (%) | 25.0 | 4.5 | 4.9 | <0.001 | <0.001 | 0.90 |
| NGT days/patient | 0.65 | 0.21 | 0.17 | 0.049 | 0.01 | 0.82 |
| Length of stay | 7.9 | 5.3 | 5.7 | <0.001 | 0.001 | 0.42 |
| First BM (d) | 4.8 | 3.7 | 3.7 | <0.001 | <0.001 | 0.95 |
| First flatus (d) | 3.9 | 3.1 | 3.0 | 0.007 | 0.006 | 0.69 |
| Tolerated solids (POD) | 5.6 | 3.9 | 3.7 | <0.001 | <0.001 | 0.65 |
CONCLUSIONS: HALS involves less postoperative ileus than open surgery and is comparable to conventional laparoscopy. Open surgery is still associated with a high incidence of postoperative ileus requiring nasogastric tube decompression.
Session: Podium Presentation
Program Number: S076