Evaluating the effect of gentamicin-clindamycin lavage on post-operational pain and infection through laparoscopic colectomy surgery / Avaliação do efeito da lavagem com gentamicina-clindamicina sobre a dor e a infecção após colectomia laparoscópica

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.

Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.

Abordaje laparoscópico simultáneo del cáncer de colon con metástasis hepáticas / Simultaneous laparoscopic approach for colon cancer and liver metastases

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología. En los pacientes con cáncer de colon con metástasis hepáticas sincrónicas (CCMHS), la resección completa del tumor primario con las metástasis es la única opción de tratamiento con intención curativa. Se conocen varios informes de series de casos en el mundo; sin embargo, no existe ningún estudio aleatorizado controlado. Objetivo: el objetivo es evaluar la factibilidad y seguridad del abordaje laparoscópico simultáneo de la resección del tumor primario de colon y de la metástasis hepática. Material y métodos: es un estudio retrospectivo; a tal fin se recolectaron todos los pacientes con sospecha de CCMHS abordados por laparoscopia con intención de resección simultánea del tumor primario de colon con las metástasis hepáticas. Se analizaron variables preoperatorias, operatorias, resultados a corto y largo plazo, y anatomopatológicas. Resultados: en el período de estudio se realizaron 89 resecciones hepáticas laparoscópicas (RHL). En 28 pacientes se realizó ‒en forma simultánea con la RHL‒ otro procedimiento, en 21 de los cuales fue una colectomía laparoscópica. El tiempo quirúrgico promedio total de los dos procedimientos llegó a 407 minutos. El promedio de días de estadía hospitalaria fue de 8 días. No hubo mortalidad en la serie, y la morbilidad global fue del 71%, pero un solo caso con morbilidad mayor. La sobrevida global y la sobrevida libre de recurrencia a los 3 años fue de 55,2% y 16,3%, respectivamente. Conclusión: Esta es la primera publicación acerca del tema en nuestro país. Podemos decir que, en casos bien seleccionados, el abordaje laparoscópico simultáneo es factible de realizar, con aceptable morbimortalidad y sin comprometer los resultados oncológicos.

Background: In patients with colorectal cancer with synchronous liver metastases (CLM), complete resection of the primary tumor with the metastases is the only option for curative treatment. Several case series have been reported but no randomized controlled trials have been published. Objective: The aim was to evaluate if the simultaneous laparoscopic resection of the primary colon tumor and liver metastases is feasible and safe. Material and methods: A retrospective study was conducted with patients with suspected CLM scheduled for simultaneous laparoscopic resection of the primary tumor of the colon and liver metastases. The preoperative and operative variables, short- and long-term outcomes and pathological variables were analyzed. Results: A total of 89 laparoscopic liver resections (LLR) were performed during the study period. In 28 patients, LLR was simultaneous with other procedures, 21 of which corresponded to laparoscopic colon resection. Mean surgical time for both procedures was 407 minutes. Mean hospital length of stay was 8 days. None of the patients died and overall morbidity rate was 71% with only one major complication. Overall survival and relapse-free survival at three years was 55.2% and 16.3%, respectively. Conclusion: This is the first publication analyzing this approach in our country. In well selected cases, the simultaneous laparoscopic approach is feasible, with low morbidity and mortality and acceptable oncological results.

Efficacy and Safety of Ramosetron Injection for Nausea and Vomiting in Colorectal-Cancer Patients Undergoing a Laparoscopic Colectomy: A Randomized, Double-Blind, Comparative Study

PURPOSE: A laparoscopic colectomy in colorectal-cancer patients is usually associated with a high risk of postoperative nausea and vomiting (PONV). The purpose of this study is to evaluate the efficacy of injection of long-acting 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist for the reduction of PONV in patients with colorectal cancer. METHODS: A total of 48 patients scheduled to undergo a laparoscopic colectomy for colorectal cancer were randomized in a double-blinded fashion. Patients were randomly allocated to 1 of 2 groups and assigned to receive either 0.3 mg of ramosetron intravenously (group A, n = 25) or 2 mL of normal saline (placebo) (group B, n = 22) immediately after the operation. The incidence of PONV, the nausea severity scale score, the visual analogue scale (VAS) score for pain, the total amount of patient-controlled analgesia used, the recovery of bowel function, and morbidities were assessed at 1 hour and at 24, 48, and 72 hours after surgery. RESULTS: The baseline and the operative characteristics were similar between the groups (P > 0.05). The number of cases without PONV (complete response) was higher for group A (ramosetron) than group B (normal saline): 24 hours after surgery, 92.0% (23 of 25) for group A versus 54.5% (12 of 22) for group B; 48 hours after surgery, 92% (23 of 25) for group A versus 81.8% (18 of 22) for group B (both P < 0.05). No serious adverse events occurred. CONCLUSION: Postoperative ramosetron injection is effective for the prevention of PONV after a laparoscopic colectomy in colorectal-cancer patients.

Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review

PURPOSE: The laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative time. Hand-assisted laparoscopic surgery (HALS) is an alternative technique that addresses these problems while preserving the short-term benefits of a laparoscopic colectomy. Our study was aimed to describe the characteristics of patients admitted due to left-sided colon and rectal cancer for HALS. METHODS: A prospectively maintained database was used to identify patients who underwent HALS at the Institute of Oncology, Vilnius University, from July 1, 2009, to October 1, 2012. RESULTS: One hundred-three HALS colorectal resections were performed. The patients' mean age was 64 +/- 13.4 years. There were 46 male and 57 female patients. The body mass index was 27.3 +/- 5.8 kg/m2. Forty-three patients (41.8%) had experienced prior abdominal surgery. The mean HALS time was 105 minutes (range, 55-85 minutes). The conversion rate was 2.7% (3/103). The median of return of gastrointestinal function was 2.5 days (range, 2.2-4.5 days). The median length of hospital stay was 9 days. The postoperative complication and mortality rates were 10.7% and 0.97%, respectively. Four incisional hernias (3.9%) were seen at a mean follow-up of 7.0 +/- 3.4 months. None of the patients had a trocar or a hand-port site recurrence. CONCLUSION: A HALS colorectal resection is a safe and effective technique, and it provides all the benefits of minimally invasive surgery.

Cirugía colónica laparoscópica sin preparación mecánica: resultados preliminares y análisis de factibilidad / Laparoscopic colectomy, without mechanical bowel cleansing: preliminary results and feasibility

Introducción: La preparación mecánica del colón (PMC) es una práctica común, utilizada por la mayoría de los cirujanos. A pesar de no existir evidencia científica significativa que la avale, se ha convertido en un dogma en la última mitad de siglo XX. La factibilidad del abordaje laparoscópico sin PMC no está aún completamente aclarada. Objetivo: el objetivo del presente estudio es evaluar la factibilidad técnica, y la seguridad del abordaje laparoscópico en cirugía colorrectal sin preparación mecánica. Diseño: análisis retrospectivo y descriptivo, de una base de datos prospectiva. Población: 108 pacientes sometidos a colectomía laparoscópica, sin PMC. Métodos: Periodo analizado: Marzo de 2007 a Marzo de 2010, Forma de registro de datos: consecutiva, sucesiva y no selectiva en una base de datos prospectiva Excel 2011 para Mac. Se tatuaron en forma sistemática todas las lesiones que el cirujano consideró de difícil localización intraoperatoria. Se analizaron variables como edad, sexo, grado de ASA, índice de masa corporal (IMC), cirugías previas, patología, tipo y duración de cirugía, tasa de conversión y su causa. Se utilizó la escala de Dindo y Clavien para categorizar la morbilidad. Para simplificar el análisis se dividieron las colectomías en dos grupos. Los resultados se compararon con los hallados en la bibliografía. Resultados: La media de edad fue 60 años (24-84), el 60% de la serie eran hombres. El 6,5% (7) de los pacientes eran obesos. 37 pacientes (45%) tuvieron una categorización de la clasificación de ASA III o mayor. El 40 % tenían antecedentes de cirugías abdominales previas. El 68% de la patología fue oncológica. Se operaron de forma programada 104 pacientes. Se realizaron 70 anastomosis en 71 colectomías izquierdas y 33 derechas. La tasa de conversión global fue del 11% (12/108). En ningún caso el motivo fue por dificultad en la manipulación del colon...

The mechanical bowel preparation (MBP) is a common practice, used by most surgeons. Despite the absence, of significant scientific evidence, has become a dogma in the latter half of the twentieth century. The feasibility of the laparoscopic approach without MBP is not yet completely clarified. Aim: the objective of this study is to evaluate the technical feasibility, and the security of laparoscopy in colorectal surgery without mechanical preparation. Design: a Descriptive and retrospective analysis has been conducted from a prospective database. Population: 108 patients who underwent a laparoscopic colonic resection without MBP were analyzed. Methods: Period: March 2007 to March 2010. A consecutive, and unselective data was registered in a prospective Excel database. All lesions were tattooed when considered difficult to locate during surgery. Variables such a as age, gender, ASA, BMI, history of surgical treatment, histopathological results, type and length of surgery, convertion rate and its causes were analyzed. Dindo and Clavien’s classification was used to categorized morbidity and mortality. In order to simplify the analysis, colectomies where dived into 2 groups: right and left procedures. Results were compared with the literature. Results: The average age found was 60 years (24-84), 60% of the patients were males. 6.5% were obese. According to the ASA classification, 37 patients (45%) were categorized as ASA III-IV. Forty percent had a history of abdominal surgeries. 68% of the surgical procedures were done for cancer. There were 104 programmed surgeries, 70 anastomosis were performed in 71 left colectomies and in 33 right colectomies. The global conversion rate was of 11% (12/108). None of this conversion was due to lack of small lesion identification. The surgical time was of 180’ (85’-360’). Morbidity rate was 21% (23/108) and the mortality rate found was 0.9% (1/108)...

Colectomía total laparóscopica para el tratamiento de inercia colónica: resultados quirúrgicos y funcionales / Laparoscopic total colectomy for colonia inertia: immediate and late results

Introducción: El abordaje laparoscópico en el tratamiento de la inercia colónica (IC) es una técnica que ha demostrado ser una excelente alternativa al abordaje clásico. Objetivo: Presentar la experiencia de la IC y los resultados funcionales obtenidos a mediano plazo luego de una colectomía total con ileorecto anastomosis (CT+IRA) por vía laparóscopica. Material y Método: Se analizaron todos los pacientes operados con diagnóstico de IC a los que se les realizó una CT+IRA vía laparóscopica, en el período 2002 al 2007. Todos poseían un completo estudio para constipación (Historia clínica, manometría ano-rectal, enema baritado, defecografía, estudio radiológico del tránsito colónico y de intestino delgado). Se analizaron las variables preoperatorios y quirúrgicas. Se realizó un seguimiento telefónico evaluando el puntaje según la escala de Wexner para constipación e incontinencia, la recomendación de la cirugía a terceros y satisfacción con el procedimiento (Escala de 1 a 10). Análisis estadístico: Test T de Student. Resultados: En el período mencionado se intervinieron 20 pacientes, todos de sexo femenino. La edad promedio fue de 41,5 años (i: 18-52). El tiempo operatorio fue de 248 minutos (i: 170-360). Hubo una conversión (5 por ciento) por dificultad anatómica. El tiempo medio hasta la expulsión de gases y la realimentación fue al 2º (i: 1-4) y 3º (i: 2-6) día respectivamente. La mediana de estadía postoperatoria fue de 7 días. Se complicaron 7 pacientes (35 por ciento) (3 íleo postoperatorios, 1 trombosis portal, 1 rectorragia, 1 colección peri anastomotica y 1 hemoperitoneo). Hubo una relaparotomía por trombosis portal, una punción percutánea por colección perianastomotica y una relaparoscopía por hemoperitoneo. No hubo mortalidad postoperatoria. Seguimiento a una mediana de 25 meses (i: 1-60); puntaje de Wexner para constipación en el preoperatorio fue 22,3 (i: 19-29) y al control postoperatorio 1,8 (i: 0-6) (p < 0,01). El nivel medio de satisfacción...

Background: Total colectomy with Neo-recto anastomosis has the best results in the treatment of colonic inertia but it is a complex procedure. Laparoscopic approach is a less invasive alternative. Aim: To report the results of laparoscopic total colectomy with Neo rectal anastomosis for the treatment of colonic inertia. Material and Methods: Review of medical records of patients with colonic inertia subjected to a laparoscopic total colectomy with Neo rectal anastomosis. All had a complete preoperative study for constipation. A telephone follow up was performed asking for constipation, fecal incontinence and if they would recommend the procedure to other patients. Results: Twenty female patients aged 18 to 52 years were operated. Mean operative time was 248 minutes. In 5 percent of patients, conversion to open surgery was required. The lapse for gas expulsion and resumption of oral feeding was two and three days after surgery, respectively. Mean hospital stay was seven days. Seven patients (35 percent) has complications (a postoperative ileus in three, a portal vein thrombosis in one, hematochezia in one and hemoperitoneum that required a new laparoscopy in one). The Wexler score for constipation was 22.3 (range 19-29) in the preoperative period and decreased to 1.8 (range 0-6) in the telephone follow up. The mean level of satisfaction was 8 (range 2-10) and only one patient would not recommend the procedure to other patients. Conclusions: Laparoscopic total colectomy for colonic inertia has a 35 percent rate of complications in immediate postoperative period and good functional results in the long term follow up.

Resultados do registro nacional brasileiro em vídeo-cirurgia colorretal - 2007 / Results of the 2007 Brazilian national registry in colorectal videosurgery

Este trabalho multicêntrico reúne a experiência de 28 equipes brasileiras em vídeo-cirurgia colorretal. No período de 1992 a 2007 foram operados 5259 pacientes, sendo excluídos 515 (9,8 por cento) doentes devido a dados incompletos. Foram avaliados 4744 pacientes, sendo 1994 homens (41,4 por cento) e 2750 mulheres (58,6 por cento), cuja idade variou de 1 a 94 anos (média de 57,5 anos). Doenças benignas foram diagnosticadas em 2355 pacientes (49,6 por cento). A maioria das afecções (50,7 por cento) localizava-se no cólon esquerdo e sigmóide, 28,2 por cento no reto e 0,3 por cento no canal anal, 8,0 por cento no cólon direito e 7,0 por cento difusa. Ocorreram 29 óbitos (1,6 por cento). Foram operados 2389 (50,4 por cento) pacientes portados de tumores malignos, estando localizados no reto em 48,5 por cento, cólon esquerdo e sigmóide 30,7 por cento, cólon direito 16 por cento, cólon transverso 3,2 por cento e canal anal 0,6 por cento. Os tipos histológicos foram 2347 (98 por cento) adenocarcinomas, 30 (0,6 por cento) carcinomas espinocelulares e outros tipos histológicos em 12 (0,2 por cento) pacientes. A recidiva global foi de 15,3 por cento. Houve 180 (3,8 por cento) complicações intra-operatórias, sendo as mais comuns lesões vasculares de cavidade e lesões de alças intestinais, com incidência de 1 por cento. Foram relatadas 261 (5,5 por cento) conversões para laparotomia, sendo a causa mais comum a dificuldade técnica em 1,4 por cento. Complicações pós-operatórias foram registradas em 683 (14,5 por cento). Em período médio de 52 meses de seguimento houve 19 (0,8 por cento) recidivas no local de inserção de trocártes. Não houve recidiva parietal em incisão utilizada para retirada da peça. CONCLUSÕES: 1) Nos últimos anos, a experiência brasileira em vídeo-cirurgia colorretal teve aumento expressivo; 2) As indicações operatórias para câncer e doenças benignas foram semelhantes, sendo que a doença diverticular representou 40 por cento...

This multicentric registry reports the experience of 28 Brazilian surgical teams specialized in laparoscopic colorectal surgery. Between 1992 and 2007, 4744 patients (1994 men - 42 percent and 2751 women - 58 percent) were operated on, with ages ranging from 1 to 94 years (average 57,5 years). Benign diseases were diagnosed in 2356 patients (49,6 percent). Most diseases (50,7 percent) were located in the left and sigmoid colon, 28,2 percent in the rectum and 0,3 percent anal canal, 8,0 percent in the right colon and difuse 7,0 percent. There were 181 (3,8 percent) intraoperative complications (0 percent to 14 percent). There were reported 261 (5,5 percent) convertions to laparotomy (0 to 16,5 percent), that were also more common during the early experience (n=119 -59,8 percent). Postoperative complications were registered in 683 (14,5 percent) patients (5,0 percent to 50, percent). Mortality occurred in 43 patients (0,8 percent). Two thousand, three hundred and eight nine (50,4 percent) malignant tumors were operated on, and histological classification showed 2347 (98 percent) adenocarcinomas, 30 (0,6 percent) spinocellular carcinomas and 12 (0,2 percent) other histological types. Overall tumor recurrence rate was15,3 percent, the majority of which (68 percent) diagnosed during the first 2 years of follow-up. After an average follow-up of 52 months, there were reported 19 (0,8 percent) parietal recurrences, eighteeng of which in port sites and one in a patient with disseminated disease. There was no incisional recurrence in the ports used to withdraw the pathologic specimen. CONCLUSIONS: 1) There was an expressive increase in the Brazilian experience during the last years; 2) Operative indications for benign and malignant diseases were similar, and diverticular disease of the colon represented 40 percent of the benign ones; 3) Complication and mortality rates were low and comparable to those reported in literature; 4) Oncological outcome...

The Early Experience of Laparoscopic Sigmoid Colon and Rectal Cancer Resection

PURPOSE: The aim of this study is to assess the pathologic surgical outcome and short-term outcome of a laparoscopic colorectal resection at an early time on the learning curve in comparison with open surgery. METHODS: Retrospectively collected data were obtained on 49 patients who underrent a laparoscopic sigmoid colon and rectal cancer resection between May 2001 and January 2006. The compared factors were the clinicopathologic characteristics, the operation time, the postoperative recovery, and complications. RESULTS: There were no significant differences in age, sex, TNM stage, and tumor size between the laparoscopic and open-surgery groups. The operation time was significantly longer in the laparoscopic group (291.4 vs. 201.9 min P < 0.001). In the view point of postoperative recovery, the laparoscopic group showed a significant advantage in the passage of flatus. There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups. The complication rate was not significantly different, but anastomotic leakage was higher in the laparoscopic group (16.7% vs. 2%, P=0.02). CONCLUSIONS: There were no significant differences in harvested LNs, proximal margin, and distal margin between the two groups, but anastomotic leakage was higher in the laparoscopic group.

Current Status of Laparoscopic Colectomy for Colon Cancer

Although laparoscopic colon resection is a widely accepted treatment for benign colon disease, many questions have been raised about its value in management of colorectal cancer. The short-term benefits of this operation, such as decreased incidence of pulmonary complications, faster return of the bowel function, decreased narcotic requirements, shortened hospital stay, and faster recovery time, are now well established. However, there are many controversies for this method as a treatment of cancer. The main issues are adequacy of oncologic resection, recurrence rates and patterns, and long-term survival. Considering the results so far reported, laparoscopic colectomy seems to be feasible and safe. Modest benefits in the quality of life are observed. Same oncologic resection can be performed laparoscopically with no adverse influence on the recurrence rate. At least, equivalent survival is obtained by laparoscopic colectomy. Even the early results of laparoscopic colectomy for cancer are encouraging, the fate of this procedure rests with the long term analysis of number of trials currently underway.

Safety and Feasibility of Laparoscopic Low Anterior Resection in Early Learning Curve

PURPOSE: After the final report of Clinical Outcomes of Surgical Therapy (COST) study group, the application of laparoscopic surgery in colon cancer a spread widely. However, laparoscopic surgery in the rectum is still regarded as a complicated procedure to start due to technical difficulties and a steep learning curve. The aim of this study was to show the safety and technical feasibility of a laparoscopic low anterior resection at an early time on the learning curve in comparison with open low anterior resection. METHODS: The learning curves of one colorectal surgeon in open and laparoscopic low anterior resections were retrospectively compared. The compared factors were clinicopathologic characteristics, operation time, and the factors associated with postoperative recovery, morbidity and mortality. RESULTS: There were no significant differences in age or sex between two groups. The operation time was significantly longer in the laparoscopy group (P<0.001) In the view point of postoperative recovery, the laparoscopy group showed significant advantages in hospital stay (P<0.001), the passage of flatus (P<0.001), the number of analgesics used (P=0.03), and the removal of foley catheter (P=0.001). There were no conversions in the laparoscopy group, and the complication rate was lower in the laparoscopy group (10.7% vs. 17.6%). There was no postoperative mortality in either group. CONCLUSIONS: Even though the operation time was significantly longer in the laparoscopy group, a laparoscopic low anterior resection appears to have some benefits in postoperative recovery and morbidity. In terms of surgical outcomes, a laparoscopic low anterior resection can be performed safely even in early times on the learning curve.

Laparoscopic Assisted Colectomy Versus Open Colectomy; Retrospective Case-Control Study

PURPOSE: Despite many reports on laparoscopic-assisted colectomies (LAC) over the past decade, the feasibility of their use in both benign and malignant disease of the colon is not clear. The purpose of this study was to evaluate the feasibility and safety of LAC for the treatment of colonic diseases. METHODS: Between April 2000 and August 2002, we attempted a laparoscopic-assisted colectomy in 95 patients (LAC group). We excluded 3 patients who had converted to open surgery. The surgical outcomes were compared with 92 matched patients who underwent conventional open surgery during the same period (open group), focusing on the results of the surgery, postoperative recovery, complications and oncologic clearance. Between the two groups, there were no significant differences in age, Dukes stage, and type of resection. RESULTS: There were 29 benign and 63 malignant diseases. The mean operating time for the LAC group and the open group were 167.9 and 95.1 minutes, respectively (P<0.00). However, the time taken for passing gas (40.4 hours vs 56.7 hours)(P=0.02) and the length of hospital stay (7.9 days vs 8.6 days) (P=0.07) were significantly shorter in the LAC group than in the open group. Nine patients in the LAC group had complications (9.7%): anastomotic site bleeding (4), chyle leakage (3), urinary retention (1), and ileus (1). All were treated conservatively. There were no differences in complication rates between the groups. The average number of harvested lymph nodes was 20.9 (2~64) in the LAC group and 21.5 (4~60) in the open group (P=0.49). The average distal resection margins were 3.7 (2.0~9.0) cm in the LAC group and 3.3 (1.0~5.0) cm in the open group (P=0.21) for an anterior resection and 3.2 (1.0~7.0) cm in the LAC group and 2.3 (0.7~7.0) cm in the open group for a low anterior resection (P=0.48). CONCLUSIONS: This study showed that LAC had an advantage over open surgery in terms of earlier recovery. Oncological clearance (the number of lymph nodes removed and the resection margins) did not differ between the two procedures. Thus, LAC is a feasible technique in the treatment of colon disease with acceptable morbidity. However, long-term data from a randomized trial is needed.

Preliminary Experience with Laparoscopic Colectomy: Comparison with Conventional Colectomy

Laparoscopic techniques are being applied to the surgical management of the colorectal disease. Comparing our twenty-month experience in laparoscopic colectomy with that of the conventional (open) colectomy, we evaluate the efficacy and the safety of laparoscopic operations in colorectal disease. From April 1994 to December 1995, thirty-five patients underwent a colorectal surgery at St. Vincent's Hospital, The Catholic University of Korea, College of Medicine. Nineteen patients (5 males and 14 females; mean age 54.8 years) were included in the laparoscopic group and fourteen patients (5 males and 9 females; mean age 50.9) were included in the open group. Two conversion cases were excepted due to unfitness for comparison. Malignancy were 15 cases in the laparoscopic group and 9 cases in the open group. To estimate the general advantage of laparoscopic surgery, we compared durations of wound pain and ileus, postoperative hospital stays, and operative time between two groups. Then surgical margins and numbers of lymph nodes harvested were compared between two groups for an evaluation of radical curability of malignant disease. The operative procedures of two groups included abdominoperineal resection, anterior resection, low anterior resection, sigmoid colectomy, right hemicolectomy, and Hartmann's procedure. The conversion rate of laparoscopic colectomy was 9.5 % (2 of 21). In the laparoscopic group, we experienced some advantages in duration of pain and ileus, and postoperative hospital stays, even though there was no statistical significance. Comparable surgical margins and numbers of lymph nodes harvested proved the laparoscopic procedures to be worthy of radical surgery. Between the two groups, morbidity and mortality showed no difference. Although the operative time of the laparoscopic group was longer than that of the open group, it can be decreased with more experience, development of better instruments, and the specialization. Even if we require a long-term survival rate, our data suggest that the laparoscopic colectomy can be accomplished effectively and safely with the accumulation of experience and the advancement of equipments.