Gastrointestinal recovery following laparoscopic vs open colon surgery
- 31 Downloads
Background: We prospectively studied the recovery of gastrointestinal motility in patients undergoing laparoscopic (LAP, n=7) or open (OPEN, n=7) colon resections.
Methods: At operation, bipolar recording electrodes were placed on the proximal and distal antrum, the proximal site of the colonic anastomosis, and the rectosigmoid for postoperative myoelectric recordings.
Results: Shorter postoperative hospitalization and earlier resumption of a regular diet of the LAP group just barely failed to achieve significant differences when compared with the OPEN group (p=0.091, p=0.050, respectively). There were no differences between groups for slow wave frequency, amplitude, or dysrhythmias in the antrum, nor for return of discrete (DERA) and continuous (CERA) electrical response activity in the colon. Percentage of slow waves with spike activity tended to increase with passage of time postoperatively in both groups. There was a significant difference between POD 3 and 7+ in the LAP group (p<0.05). However, there were no significant differences in the percentage of slow waves with spike activities between groups on any postoperative day.
Conclusions: The potential benefits of using a laparoscopic approach to colon resection are not clearly confirmed by these data. While such an approach may possibly result in shorter hospitalization, it appears to offer at best only modest increases in the rapidity of recovery of gastrointestinal function.
Key wordsLaparoscopy Colon surgery Gastrointestinal motility Postoperative ileus
Unable to display preview. Download preview PDF.
- 1.Bueno L, Ferre JP, Ruckebusch Y (1978) Effect of anesthesia and surgical procedures on intestinal myoelectric activity in rats. Am J Dig Dis 23: 690–695Google Scholar
- 2.Dubois A (1989) Gastric dysrhythmias: pathophysiologic and etiologic factors. Mayo Clin Proc 64: 246–250Google Scholar
- 3.Elftmann TD, Nelson H, Ota DM, Pemberton JH, Beart RW Jr (1994) Laparoscopic-assisted segmental colectomy: surgical techniques. Mayo Clin Proc 69: 825–833Google Scholar
- 4.Hinder RA, Kelly KA (1978) Human gastric pacesetter potential. Site of origin, spread and response to gastric trans-section and proximal gastric vagotomy. Am J Surg 133: 29–33Google Scholar
- 5.Hocking MP, Vogel SB, Sninsky CA (1992) Human gastric myoelectric activity and gastric emptying following gastric surgery and with pacing. Gastroenterology 103: 1811–1816Google Scholar
- 6.Hoffman GC, Baker JW, Fitchett CW, Vansant JH (1994) Laparoscopic-assisted colectomy: initial experience. Ann Surg 219: 732–743Google Scholar
- 7.Ludwig KA, Frantzides CT, Carlson MA, Grade KL (1993) Myoelectrical motility patterns following open versus laparoscopic cholecystectomy. J Laparendosc Surg 3: 461–466Google Scholar
- 8.Moss G, Regal ME, Lichtig L (1986) Reducing postoperative pain, narcotics and length of hospitalization. Surgery 90: 206–210Google Scholar
- 9.Nachlas MM, Younis MT, Roda CP, Wityk JJ (1972) Gastrointestinal motility studies as a guide to postoperative management. Ann Surg 175: 510–522Google Scholar
- 10.Nelsen TS, Kohatsu S (1968) Clinical electrogastrography and its relationship to gastric surgery. Am J Surg 116: 215–222Google Scholar
- 11.Sarna SK (1991) Physiology and pathophysiology of colonic motor activity: part one of two. Dig Dis Sci 36: 827–862Google Scholar
- 12.Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS (1991) Laparoscopic cholecystectomy: treatment of choice for symptomatic cholelithiasis. Ann Surg 213: 665–677Google Scholar
- 13.Waldhausen JH, Shaffrey ME, Skenderis BS Jr, Jones RS, Schirmer BD (1990) Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 211: 777–785Google Scholar
- 14.Wexner SD, Cohen SM, Johansen OB, Nogueras JJ, Jagelman DG (1993) Laparoscopic colorectal surgery: a prospective assessment and current perspective. Br J Surg 80: 1602–1605Google Scholar
- 15.Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG (1992) Laparoscopic total abdominal colectomy. A prospective trial. Dis Colon Rectum 35: 651–655Google Scholar