Diseases of the Colon & Rectum

, Volume 36, Issue 1, pp 28–34 | Cite as

Laparoscopic colectomy: A critical appraisal

  • P. M. Falk
  • R. W. BeartJr.
  • S. D. Wexner
  • A. G. Thorson
  • D. G. Jagelman
  • I. C. Lavery
  • O. B. Johansen
  • R. J. FitzgibbonsJr.
Original Contributions
  • 83 Downloads

Abstract

A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups (P<0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group (P< 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.

Key words

Laparoscopy Laparoscopic colectomy Colectomy Colon resection Colon and rectal surgery 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Berci G, Sackier JM. The Los Angeles experience with laparoscopic cholecystectomy. Am J Surg 1991;161:382–4.CrossRefPubMedGoogle Scholar
  2. 2.
    Cuschieri A, Dubois F, Mouiel J,et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161:385–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Flowers JL, Bailey RW, Scovill WA, Zucker KA. The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg 1991;161:388–92.CrossRefPubMedGoogle Scholar
  4. 4.
    Arregui ME, Davis CJ, Arkush A, Nagan RF. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1991;1:240–5.PubMedGoogle Scholar
  5. 5.
    Peters JH, Ellison EC, Innes JT,et al. Safety and efficacy of laparosocpic cholecystectomy. Ann Surg 1991;213:3–12.PubMedGoogle Scholar
  6. 6.
    Wexner SD, Johansen OB. Laparoscopic bowel resection: advantages and limitations. Ann Med 1992;24:105–10.PubMedGoogle Scholar
  7. 7.
    Nogueras JJ, Wexner SD. Laparoscopic colorectal surgery. Perspect Colon Rectal Surg 1992 (in press).Google Scholar
  8. 8.
    Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic total abdominal colectomy: a prospective trial. Dis Colon Rectum 1991;35:651–5.Google Scholar
  9. 9.
    Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surgical Laparosc Endosc 1991;1:144–50.Google Scholar
  10. 10.
    Blenkinsopp WK, Stewart-Brown S, Blesovsky L,et al. Histopathology reporting in large bowel cancer. J Clin Pathol 1981;34:509–13.PubMedGoogle Scholar
  11. 11.
    Scott KW, Grace RH. Detection of lymph node metastases in colorectal carcinoma before and after fat clearance. Br J Surg 1989;76:1165–7.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1993

Authors and Affiliations

  • P. M. Falk
    • 1
  • R. W. BeartJr.
    • 2
  • S. D. Wexner
    • 3
  • A. G. Thorson
    • 1
  • D. G. Jagelman
    • 3
  • I. C. Lavery
    • 4
  • O. B. Johansen
    • 3
  • R. J. FitzgibbonsJr.
    • 1
  1. 1.Section of Colon and Rectal Surgery, Department of SurgeryCreighton University School of MedicineOmaha
  2. 2.Department of SurgeryUniversity of Southern CaliforniaLos Angeles
  3. 3.Department of Colon and Rectal SurgeryCleveland Clinic FloridaFort Lauderdale
  4. 4.Department of Colon and Rectal SurgeryCleveland Clinic FoundationCleveland

Personalised recommendations