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Laparoscopic- vs. Hand-Assisted Ultralow Anterior Resection: A Prospective Study

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

A standard laparoscopic-assisted operation can be conducted with colorectal anastomosis performed after extraction of specimen and insertion of a pursestring via a small left iliac fossa or suprapubic incision, or completed via hand-assisted laparoscopic technique with a 7-cm to 8-cm suprapubic incision. This study compares the short-term outcomes of either technique.

Methods

Sixty-three consecutive patients undergoing laparoscopic-assisted ultralow anterior resection or total mesorectal excision for rectal cancer were examined. The laparoscopic-assisted group (n = 31) had standard laparoscopic-assisted resection, whereas the hand-assisted laparoscopic group (n = 32) had a 7-cm to 8-cm suprapubic incision to allow an open colorectal anastomosis. In patients who were obese or have had multiple abdominal surgeries, the hand-assisted approach was generally favored. All patients had a diverting ileostomy.

Results

There was no conversion in either group. Mean operating time was significantly longer in the laparoscopic-assisted group (188.2 vs. 169.8 minutes; P < 0.0001). Mean duration for narcotic analgesia (1.65 vs. 3.38 days, P < 0.0001), mean time to flatus (1.97 vs. 3.19 days, P < 0.0001), and mean duration of intravenous hydration (2.45 vs. 3.88 days, P < 0.0001) were longer in the hand-assisted laparoscopic group. However, the mean length of hospital stay (5.8 vs. 5.9 days, P = 0.379) was similar. There was no major surgical complication in either group; chest infection, wound infection, and thrombophlebitis were similar between the laparoscopic-assisted group and the hand-assisted laparoscopic group. Adequacy of specimen harvest (distal tumor margins, P = 0.995; circumferential resection margin, P = 0.946; number of lymph nodes, P = 0.845) was similar.

Conclusions

Although both laparoscopic-assisted and hand-assisted laparoscopic surgeries are safe and feasible for ultralow anterior resection, the hand-assisted technique significantly shortens operating time.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Epworth Hospital, University of Melbourne, Melbourne, Australia

    Joe J. Tjandra M.D., F.R.A.C.S., Miranda K. Y. Chan M.B.B.S., F.R.A.C.S. & Chung Hung Yeh M.D.

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  1. Joe J. Tjandra M.D., F.R.A.C.S.
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  2. Miranda K. Y. Chan M.B.B.S., F.R.A.C.S.
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  3. Chung Hung Yeh M.D.
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Corresponding author

Correspondence to Miranda K. Y. Chan M.B.B.S., F.R.A.C.S..

Additional information

†Deceased.

Read at the meeting of The American Society of Colon and Rectal Surgeons, St. Louis, Missouri, June 2 to 6, 2007.

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Tjandra, J.J., Chan, M.K.Y. & Yeh, C.H. Laparoscopic- vs. Hand-Assisted Ultralow Anterior Resection: A Prospective Study. Dis Colon Rectum 51, 26–31 (2008). https://doi.org/10.1007/s10350-007-9107-1

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  • DOI: https://doi.org/10.1007/s10350-007-9107-1

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