S R Brown1, K W Eu, F Seow-Choen. 1. Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Abstract
PURPOSE: Compared with open restorative proctocolectomy, laparoscopic procedures may reduce postoperative recovery times and give a more cosmetically acceptable scar, but operative time may be prolonged. We describe a minilaparotomy technique for restorative proctocolectomy and compare recovery parameters with a laparoscopic procedure. METHODS: A consecutive series of patients undergoing laparoscopic-assisted restorative proctocolectomy were compared with a subsequent consecutive series of patients undergoing a minilaparotomy procedure. This method incorporates a suprapubic incision. Mobilization of the colon is performed in the usual manner with visualization of less accessible areas made possible by using an illuminated St. Mark's retractor. Operative and recovery parameters were analyzed for each group retrospectively. RESULTS: Twenty-five patients were compared (12 in the laparoscopic group). Wound length was significantly longer in the open group (median, 14 vs. 8.5 cm; P < 0.01), but operative times were shorter (median, 120 vs. 150 minutes; P < 0.01). There were no differences in any of the recovery parameters analyzed, including analgesic requirements, time to ileostomy function, first fluid intake, time to solid diet, length of hospital stay, and complications. CONCLUSION: The only advantage of a laparoscopic-assisted procedure over a minilaparotomy technique was the size of the wound. The minilaparotomy restorative proctocolectomy achieves the same postoperative recovery parameters and has a shorter operative time. This technique is recommended for surgeons less experienced in laparoscopy.
PURPOSE: Compared with open restorative proctocolectomy, laparoscopic procedures may reduce postoperative recovery times and give a more cosmetically acceptable scar, but operative time may be prolonged. We describe a minilaparotomy technique for restorative proctocolectomy and compare recovery parameters with a laparoscopic procedure. METHODS: A consecutive series of patients undergoing laparoscopic-assisted restorative proctocolectomy were compared with a subsequent consecutive series of patients undergoing a minilaparotomy procedure. This method incorporates a suprapubic incision. Mobilization of the colon is performed in the usual manner with visualization of less accessible areas made possible by using an illuminated St. Mark's retractor. Operative and recovery parameters were analyzed for each group retrospectively. RESULTS: Twenty-five patients were compared (12 in the laparoscopic group). Wound length was significantly longer in the open group (median, 14 vs. 8.5 cm; P < 0.01), but operative times were shorter (median, 120 vs. 150 minutes; P < 0.01). There were no differences in any of the recovery parameters analyzed, including analgesic requirements, time to ileostomy function, first fluid intake, time to solid diet, length of hospital stay, and complications. CONCLUSION: The only advantage of a laparoscopic-assisted procedure over a minilaparotomy technique was the size of the wound. The minilaparotomy restorative proctocolectomy achieves the same postoperative recovery parameters and has a shorter operative time. This technique is recommended for surgeons less experienced in laparoscopy.
Authors: Stefan Maartense; Michalda S Dunker; J Frederick Slors; Miguel A Cuesta; Dirk J Gouma; Sander J van Deventer; Ad A van Bodegraven; Willem A Bemelman Journal: Ann Surg Date: 2004-12 Impact factor: 12.969
Authors: Nicolás A Rotholtz; María L Aued; Sandra M Lencinas; Gerardo Zanoni; Mariano Laporte; Maximiliano Bun; Luis Boerr; Norberto A Mezzadri Journal: Surg Endosc Date: 2007-11-20 Impact factor: 4.584