BACKGROUND: Laparoscopic-assisted colon resection has been shown to result in earlier return of bowel function, decreased postoperative pain, decreased length of stay, and decreased morbidity when compared to open resection. Laparoscopic-assisted hemicolectomy often still involves externalization of the bowel for resection and anastomosis. The aim of this study was to determine short-term outcomes of performing intra- versus extracorporeal resection and anastomosis in laparoscopic-assisted hemicolectomy. METHODS: Retrospective chart review of 105 consecutive patients who underwent laparoscopic-assisted hemicolectomy or colectomy by a single surgeon from January 2006 through August 2008 was performed. Pearson chi(2) and Student's t test were used to test for significance. RESULTS: There were 105 patients in total who underwent laparoscopic-assisted ileocolic resection (66), right hemicolectomy (29), left hemicolectomy (9), and subtotal colectomy (1). There were more males in the extracorporeal group, but patients in the two groups were otherwise demographically comparable. An intracorporeal anastomosis was performed in 54 patients and extracorporeal in 51 patients. The operation was longer in the intracorporeal group (p <or= 0.001), but estimated blood loss was less (p = 0.014). Postoperatively, there was no significant difference in time to bowel movement between the intra- and extracorporeal anastomosis groups; however, there was earlier return of flatus (2 vs. 2.4 days, respectively; p = 0.017). Postoperative narcotic use (16 vs. 49 mg morphine equivalents; p = 0.001), length of stay (3.2 vs. 3.8 days; p = 0.012), and perioperative morbidity (6 vs. 15 patients; p = 0.019) were all decreased in the intra- versus extracorporeal group, respectively. There was no perioperative mortality. CONCLUSION: In comparison to the extracorporeal technique, resection and creation of the anastomosis intracorporeally produces superior results with earlier return of bowel function, decreased postoperative narcotic use, and decreased length of stay and morbidity. Further studies will be needed to verify our findings.
BACKGROUND: Laparoscopic-assisted colon resection has been shown to result in earlier return of bowel function, decreased postoperative pain, decreased length of stay, and decreased morbidity when compared to open resection. Laparoscopic-assisted hemicolectomy often still involves externalization of the bowel for resection and anastomosis. The aim of this study was to determine short-term outcomes of performing intra- versus extracorporeal resection and anastomosis in laparoscopic-assisted hemicolectomy. METHODS: Retrospective chart review of 105 consecutive patients who underwent laparoscopic-assisted hemicolectomy or colectomy by a single surgeon from January 2006 through August 2008 was performed. Pearson chi(2) and Student's t test were used to test for significance. RESULTS: There were 105 patients in total who underwent laparoscopic-assisted ileocolic resection (66), right hemicolectomy (29), left hemicolectomy (9), and subtotal colectomy (1). There were more males in the extracorporeal group, but patients in the two groups were otherwise demographically comparable. An intracorporeal anastomosis was performed in 54 patients and extracorporeal in 51 patients. The operation was longer in the intracorporeal group (p <or= 0.001), but estimated blood loss was less (p = 0.014). Postoperatively, there was no significant difference in time to bowel movement between the intra- and extracorporeal anastomosis groups; however, there was earlier return of flatus (2 vs. 2.4 days, respectively; p = 0.017). Postoperative narcotic use (16 vs. 49 mg morphine equivalents; p = 0.001), length of stay (3.2 vs. 3.8 days; p = 0.012), and perioperative morbidity (6 vs. 15 patients; p = 0.019) were all decreased in the intra- versus extracorporeal group, respectively. There was no perioperative mortality. CONCLUSION: In comparison to the extracorporeal technique, resection and creation of the anastomosis intracorporeally produces superior results with earlier return of bowel function, decreased postoperative narcotic use, and decreased length of stay and morbidity. Further studies will be needed to verify our findings.
Authors: Ruben Veldkamp; Esther Kuhry; Wim C J Hop; J Jeekel; G Kazemier; H Jaap Bonjer; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio M Lacy Journal: Lancet Oncol Date: 2005-07 Impact factor: 41.316
Authors: Pierre J Guillou; Philip Quirke; Helen Thorpe; Joanne Walker; David G Jayne; Adrian M H Smith; Richard M Heath; Julia M Brown Journal: Lancet Date: 2005 May 14-20 Impact factor: 79.321
Authors: Mark Buunen; Ruben Veldkamp; Wim C J Hop; Esther Kuhry; Johannes Jeekel; Eva Haglind; Lars Påhlman; Miguel A Cuesta; Simon Msika; Mario Morino; Antonio Lacy; Hendrik J Bonjer Journal: Lancet Oncol Date: 2008-12-13 Impact factor: 41.316
Authors: Heidi Nelson; Daniel J Sargent; H Sam Wieand; James Fleshman; Mehran Anvari; Steven J Stryker; Robert W Beart; Michael Hellinger; Richard Flanagan; Walter Peters; David Ota Journal: N Engl J Med Date: 2004-05-13 Impact factor: 91.245
Authors: Mark H Hanna; Grace S Hwang; Michael J Phelan; Thanh-Lan Bui; Joseph C Carmichael; Steven D Mills; Michael J Stamos; Alessio Pigazzi Journal: Surg Endosc Date: 2015-12-29 Impact factor: 4.584