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Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study

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Abstract

Background

Although evidence suggests that laparoscopic colectomy (LC) results in faster gastrointestinal (GI) recovery than open bowel resection, previous studies were performed at single institutions or generally not controlled for diet introduction or perioperative care, making the results difficult to interpret. A prospective, observational, multicenter study was planned to investigate GI recovery, length of hospital stay (LOS), and postoperative ileus (POI)-related morbidity after LC.

Methods

Patients scheduled to undergo LC or hand-assisted laparoscopic (HAL) bowel resection and to receive opioid-based postoperative intravenous patient-controlled analgesia were enrolled in 16 U.S. centers. The study design was similar to that for trials of alvimopan phase 3 open laparotomy bowel resection using a standardized accelerated postoperative care pathway. The primary end points were time to upper and lower GI recovery (GI-2: toleration of solid food and bowel movement) and postoperative LOS. The secondary end points included POI-related morbidity (postoperative nasogastric tube insertion or investigator-assessed POI resulting in prolonged hospital stay or readmission), conversion rate, and protocol-defined prolonged POI (GI-2 > 5 postoperative days).

Results

In this study, 148 patients received hemicolectomy by the LC (42 left and 67 right) or HAL (39 left) approach. The conversion rate was 18.8% (25.4% LC left, 17.3% HAL left, 15% LC right). The mean time to GI-2 recovery was 4.4 days, and the mean postoperative LOS was 4.9 days, neither of which varied substantially by surgical approach. Prolonged POI occurred for 15 patients (10.1%), and POI-related morbidity occurred for 17 patients (11.5%). No patients were readmitted because of POI, whereas 3 patients (2%) were readmitted for all other causes.

Conclusions

Mean GI recovery and LOS after LC were accelerated compared with those for patients in open laparotomy bowel resection clinical trials or those reported in large hospital databases (0.7 and 1.7–2.2 days, respectively). Overall POI-related morbidity was similar between the open bowel resection and LC populations, demonstrating that POI continues to present with important morbidity regardless of the surgical approach.

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Acknowledgments

Support for this study and medical editorial assistance were provided by Adolor Corporation and GlaxoSmithKline. We thank Bret A. Wing, ProEd Communications, Inc., Beachwood, Ohio, for his medical editorial assistance with this manuscript.

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Authors and Affiliations

  1. Division of Colorectal Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA

    Conor P. Delaney

  2. Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA, USA

    Peter W. Marcello

  3. Department of Surgery, Weill Cornell Medical Center, New York, NY, USA

    Toyooki Sonoda

  4. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Paul Wise

  5. Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA

    Joel Bauer

  6. Adolor Corporation, Exton, PA, USA

    Lee Techner

Authors
  1. Conor P. Delaney
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  2. Peter W. Marcello
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  3. Toyooki Sonoda
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  4. Paul Wise
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  5. Joel Bauer
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  6. Lee Techner
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Correspondence to Conor P. Delaney.

Additional information

Accepted as an oral presentation at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2009 meeting.

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Delaney, C.P., Marcello, P.W., Sonoda, T. et al. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24, 653–661 (2010). https://doi.org/10.1007/s00464-009-0652-7

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  • DOI: https://doi.org/10.1007/s00464-009-0652-7

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