Abstract
Background: This study was performed to prospectively assess the results of our first 140 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal operations.
Methods: The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, and length of ileus and hospitalization.
Results: 140 laparoscopic and laparoscopic-assisted procedures were performed between May 1991 and January 1995. The mean patient age was 48 (range 12–88) years; there were 78 males and 62 females. Indications for surgery included inflammatory bowel disease in 47, colorectal carcinoma in 19, diverticular disease in 17, polyps in 16, familial polyposis in 7, colonic inertia in 7, fecal incontinence in 11, sigmoidocele in 3, irradiation proctitis in 3, rectal prolapse in 2, intestinal lymphoma in 2, and miscellaneous conditions in 6. The procedures included 38 total abdominal colectomies (TAC) (ileoanal reservoir 28, ileorectal anastomosis 8 and end ileostomy 2); 70 segmental resections of the colon, small bowel, and rectum; 18 diverting stoma creations; 10 reversal of Hartmann's procedures; and 4 other procedures. In 15 cases, the laparoscopic procedure was converted to a laparotomy (11%); 31 patients (22%) sustained 37 complications, which included: enterotomies (7), hemorrhage (10), intraabdominal abscess (4), prolonged ileus (6), wound infection (4), intestinal obstruction (2), anastomotic leak (1), aspiration (1), cardiac arrhythmia (1), and upper intestinal bleeding (1); there was no mortality. The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 17%, others 9%), P<0.05. The mean length of operating time was 4 (range 2.5–6.5) h for TAC, 2.6 (range 1.5–5.5) h for segmental colonic resections, and 1.7 (range 0.7–4) for all other procedures. The length of ileus was 3.5 (range 2–7) days after TAC, 3 (range 2–7) after the segmental resections and 2 (range 1–4) after the other procedures. The mean length of hospital stay was 6.8 (2–40) days (8.4, 6.5, and 6.3 days for the TAC, segmental resections, and other procedures, respectively).
Conclusion: The feasibility of laparoscopic colorectal surgery has been well established. TAC is associated with a higher complication rate compared to other laparoscopic colorectal procedures.
Similar content being viewed by others
References
Bauer J, Harris MT, Grumbach NM, Gorfine SR (1994) Laparoscopic assisted intestinal resection for Crohn's disease: initial experience. Surg Endosc 8: 232 [Abstr]
Binderow SR, Wexner SD (1994) Current surgical therapy for mucosal ulcerative colitis. Dis Colon Rectum 37(6): 610–624
Dubois F (1991) Laparoscopic cholecystectomy: historical perspective and personal experience. Surg Laparosc Endosc 1: 52–57
Etienne J, Jehaes C, Kartheuser A, de Neve de Roden A (1993) Laparoscopic surgery for benign colorectal disease: a multicentric prospective study. Br J Surg 80: S45 [Abstr]
Falk PM, Beart RW, Wexner SD, Thorson AG, Jagelman DG, Fitzgibbons R Jr, Johansen OB (1993) Laparoscopic colectomy: a critical appraisal. Dis Colon Rectum 36: 28–34
Franklin ME, Ramos R, Rosenthal D, Schuessler W (1993) Laparoscopic colonic procedures. World J Surg 17: 51–56
Geis WP, Miller CE, Kokoszka JS, Ferlman JC, Teresi M, Saletta JD (1992) Laparoscopic appendectomy for acute appendicitis: rational and technical aspects. Contemp Surg 40: 13–19
Gotz F, Pier A, Backer C (1992) Modified laparoscopic appendectomy in surgery. Surg Endosc 4: 6–9
Guillou P, Darzi A, Monson JRT (1993) Experience with laparoscopic colorectal surgery for malignant disease. Surg Oncol 2: 43–50
Kreissler-Haag D, Hildebrandt U, Pistorius G, Schüder G, Lindemann W, Feifel G (1994) Laparoscopic surgery in Crohn's disease. Surg Endosc 8: 1002 [Abstr]
Larach SW, Salomon MC, Williamson RP, Goldstein E (1993) Laparoscopic assisted colectomy: experience during the learning curve. Coloproct 1: 38–41
Milsom JW, Lavery IC, Bohm B, Fazio VW (1993) Laparoscopically assisted ileocolectomy in Crohn's disease. Surg Laparosc Endosc 3: 77–80
Monson JRT, Darzi A, Carey PD, Guillou PJ (1992) Prospective evaluation of laparoscopic assisted colectomy in an unselected group of patients. Lancet 340: 831–833
Musser DJ, Boorse RC, Madera F, Reed JF III (1994) Laparoscopic colectomy: at what cost? Surg Laparosc Endosc 4: 1–5
Nduka CC, Monson JRT, Menzies-Gow N, Darzi A (1994) Abdominal wall metastases following laparoscopy. Br J Surg 81: 648–652
Nogueras JJ, Wexner SD (1993) Surgical management of primary and recurrent Crohn's disease. Probl Gen Surg (1994) 10: 123–135
Peters WR, Bartels TL (1993) Minimally invasive colectomy: are the potential benefits realized? Dis Colon Rectum 36: 751–756
Pfeifer J, Wexner SD, Reissman P, Bernstein M, Singh G, Weiss EG (1995) Laparoscopic vs open colectomy: cost effectiveness and outcome. Surg Endosc 9: 1322–1326
Phillips EH, Franklin M, Carroll BJ, Fallas MJ, Ramos R, Rosenthal D (1992) Laparoscopic colectomy. Ann Surg 216: 703–707
Puente I, Sosa JL, Sleeman D, Desai V, Tranakas N, Hartmann R (1994) Laparoscopic assisted colorectal surgery. J Laparoendosc Surg 4: 1–7
Quattlebaum JK Jr, Flanders HD, Usher CH (1993) Laparoscopically assisted colectomy. Surg Laparosc Endosc 3: 81–87
Ramos JM, Beart RW Jr, Goes R, Ortega AE, Schlinkert RT (1995) Role of laparoscopy in colorectal surgery. Dis Colon Rectum 38: 494–501
Reissman P, Wexner SD, Cohen SM, Nogueras JJ, Jagelman DG (1994) Complications of laparoscopic colorectal surgery. Surg Endosc 8: 562 [Abstr]
Reissman P, Piccirillo M, Ulrich A, Nogueras JJ, Wexner SD (in press) Functional outcome of the double stapled ileoanal reservoir. J Am Coll Surg
Romero CA, James KM, Cooperstone LM, Mishrick AS, Ger R (1992) Laparoscopic sigmoid colostomy for perianal Crohn's disease. Surg Laparosc Endosc 2: 148–151
Scoggin SD, Frazee RC, Snyder SK, Hendricks JC, Roberts JW, Symmonds RE, Smith RW (1993) Laparoscopic assisted bowel surgery. Dis Colon Rectum 36: 747–750
Senagore AJ, Luchtefeld MA, MacKeighan JM, Mazier WP (1993) Open colectomy versus laparoscopic colectomy: are there differences? Am Surg 59: 549–554
The Southern Surgeon's Club (1991) A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 324: 1073–1078
Spau A, Reddick EJ, Olsen DO (1991) Laparoscopic laser cholecystectomy: analysis of 500 procedures. Surg Laparosc Endosc 1: 2–7
Tucker JG, Ambroze WL, Orangio GR, Duncan TD, Mason EM, Lucas GW (1995) Laparoscopically assisted bowel surgery: analysis of 114 cases. Surg Endosc 9: 297–300
Vara-Thorbeck C, Garcia-Cavallero M, Salvi M, Gutstein D, Toscano R, Gomez A, Vara-Thorbeck R (1994) Indications and advantages of laparoscopic assisted colon resection for carcinoma in elderly patients. Surg Laparosc Endosc 4: 110–118
Wexner SD, Cohen SM (1995) Port site metastases after laparoscopic colorectal surgery for cure of malignancy. Br J Surg 82: 295–298
Wexner SD (1991) General principles of surgery in ulcerative colitis and Crohn's disease. Semin Gastrointest Dis 2:90–98
Wexner SD, Reissman P (1992) Laparoscopic colorectal surgery: a provocative critique. Int Surg 72: 235–239
Zucker KA, Pitcherd E, Martin DT, Ford RS (1994) Laparoscopic assisted colon resection. Surg Endosc 8: 12–18
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wexner, S.D., Reissman, P., Pfeifer, J. et al. Laparoscopic colorectal surgery. Surg Endosc 10, 133–136 (1996). https://doi.org/10.1007/BF00188358
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00188358