Totally laparoscopic Colon Surgery: Single group experience.

Gilberto Lozano-Dubernard, MD¹, Ramon Gil-Ortiz, MD¹, Javier Lopez-Gutierrez, MD¹, Gustavo Reyes-Rodriguez, MD¹, Fidel Ruiz-Healy, MD². ¹, Hospital Angeles del Pedregal, Mexico City, Mexico, ²Centro Hospitalario Sanatorio Durango, Mexico City, Mexico

Introduction: Laparoscopic procedures have been reaching all surgical specialties, performing the most difficult operations and replacing open surgery as the golden standard. We started in 1995 with laparoscopic colectomy. The aim was to decrease the surgical trauma by reducing the incision size on the abdominal wall. Results have been reduction in hospitalization time, post-operative recovery, pain and return to normal life.

Methods: In a ten-year period (1995–2014), retrospective study of charts of patients who underwent total laparoscopic colorectal surgery were reviewed. One hundred ten surgical procedures were performed in 49 male (mean 49 years) and 61 female patients (mean 50 years). Forty eight patients were treated for complicated left colon diverticular disease, 24 for megacolon, 8 for volvulus, 6 for non complicated diverticular disease, 3 for colostomy closure, 3 for right colon complicated diverticular disease, and 18 patients for benign and malignant tumors, perforation, ileostomy closure, anastomotic stenosis, necrotic colitis and other diseases.

Results: Mean surgical time was 180 minutes, mean blood loss 100 cc; oral intake 24 hours after surgery and mean hospitalization time was 3 days. No mortality was reported and complications were encountered in nine patients. Complication were 1 abdominal wall abscess, 1 incisional hernia, 1 intestinal occlusion, 3 anastomosis stenosis (only one required surgical intervention), 1 perforation due to a radiological procedure; 1 anastomosis leak and 1 postoperative bleeding managed with transfusion. All cases were performed by totally laparoscopic, intracorporeal anastomosis and extraction of surgical specimen through the anus. Six patients (5.4%) required an abdominal incision to extract the specimen because size did not allow anal extraction.

Conclusion: Laparoscopic colectomy is a feasible and replicable technique rapidly gaining favor among patients, surgeons and industry. Our experience is positive in terms of complications, postoperative pain and patient satisfaction. Further comparative studies between open and laparoscopic surgery are necessary in order to keep evaluating its real value in terms of advantages and disadvantages in colorectal surgery.

Keywords: Laparoscopic colon surgery.