Effect of Topical Lidocaine Patch on Postoperative Pain Management in Laparoscopic Appendectomy: A Randomized, Double-Blind, Prospective Study.

BACKGROUND: Adequate pain control is a major concern in the immediate postoperative period. In multiple strategies for postoperative pain management, topical analgesics have significant advantages of minimizing severe side effects caused by oral and parenteral administration and drug-drug interactions. Therefore, we studied the effect of lidocaine patch on postoperative pain control in laparoscopic appendectomy. PATIENTS AND METHODS: This randomized double-blind prospective controlled study enrolled 40 acute appendicitis cases that were treated by laparoscopic appendectomy and randomly divided into two groups. Lidocaine patches containing lidocaine 175 mg was applied to the umbilical trocar site of each patient, and pain intensity was assessed with the visual analog scale every 6 hours up to 48 hours after laparoscopic appendectomy. RESULTS: There was no significant difference in age, gender, body mass index, the American society of anesthesiologists score, comorbidity, or underlying disease between the lidocaine patch and control groups. The postoperative pain scores were lower in the lidocaine patch group than in the control group, but statistical significance was not noted at the trocar site or the right lower quadrant of the abdomen (P = .320 and P = .903, respectively). The mean amounts of pethidine used after surgery were significantly smaller in the lidocaine patch group than in the control group (0.10 ± 0.31 mg versus 0.25 ± 0.79 mg, P < .001). CONCLUSIONS: The results of this study suggest that lidocaine patch application to the trocar site after laparoscopic appendectomy may have a positive effect on the management of postoperative pain and can eliminate the need to inject additional analgesics for further postoperative pain control.

Laparoscopic resection of transverse colon cancer: long-term oncologic outcomes in 58 patients.

BACKGROUND: Although the advantages of laparoscopic colectomy have been demonstrated, there are few data available on laparoscopic resection of transverse colon cancer. The purpose of this study was to assess operative outcomes, long-term survival, and disease recurrence after laparoscopic resection of transverse colon cancer. SUBJECTS AND METHODS: Prospective data were collected from 58 patients with transverse colon cancer among 1141 colorectal cancer cases undergoing laparoscopic resection between February 2001 and July 2009. Cancers located in both flexures were excluded. RESULTS: The surgical procedures included 39 extended right hemicolectomies, 11 extended left hemicolectomies, 5 transverse colectomies, and 3 total abdominal colectomies. The mean operating time was 216 minutes, and the mean operative blood loss was 111 mL. The average harvested lymph nodes were 35.8. The proximal and distal resection margins were 20.27 cm and 15.23 cm, respectively. Eight patients developed minor complications postoperatively, but these cases were controlled conservatively without interventions. One patient was converted to an open procedure because of severe adhesions. There were no surgery-related deaths. The mean follow-up period was 40.5 months. There were no local recurrences during the follow-up period. Systemic recurrence developed in four patients: two in the liver and two with peritoneal seeding. The overall and disease-free survival rates at 5 years were 84.6% and 89.3%, respectively. CONCLUSIONS: Compared with previously published multicenter studies such as the COST, COLOR, and CLASICC trials, the long-term outcomes of this study demonstrate that transverse colon cancer can safely be resected using the laparoscopic technique in experienced hands.

Anastomotic leakage after laparoscopic protectomy can be managed by a minimally invasive approach.

PURPOSE: This study was designed to identify the clinical features of anastomotic leakage after laparoscopic resection of rectal cancer and to evaluate the outcomes of laparoscopic management for this problem. METHODS: Prospectively collected data were obtained from 307 patients with rectal cancer who underwent laparoscopic proctectomy and primary anastomosis. Age, sex, tumor location, tumor stage, body mass index, comorbidities, ileostomy, conversion, intraoperative blood loss, operative time, previous abdominal operation, and hospital stay were analyzed for patients with or without anastomotic leakage. Management and outcome of anastomotic leakage also were analyzed. RESULTS: Anastomotic leakage occurred in 29 patients (9.4 percent). Diverting ileostomy was initially fashioned in 65 patients (21.2 percent). Leakage was related to young age, male sex, lower tumor location, and longer operation time. Ten patients (34.5 percent) were successfully managed with conservative treatment. Seventeen patients (58.6 percent) were managed via a laparoscopic approach. Open surgery was performed in two patients who showed diffuse fecal soiling or had previous conversion, respectively. There was no mortality. CONCLUSIONS: When leakage occurs, laparotomy or colostomy is not needed routinely. For surgical intervention, the abdominal cavity should be explored first by laparoscopic visualization because the majority of patients can be successfully managed with laparoscopy and ileostomy.

Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients.

BACKGROUND: This study aimed to prospectively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon. METHODS: Three hundreds twelve patients (male, 181) were enrolled in this analysis. 257 patients (82.4%) had tumors located below 12 cm from the anal verge. Distribution of TNM stages was 0:I:II:III:IV = 4.2%:17.9%:32.4%:37.2%:8.3%. 225 patients (71.1%) had T3/T4 lesions. Pre- and post-operative radiation was given in 6 and 20 patients, respectively. RESULTS: Sphincter-preserving operation was performed in 85.9%. Mean operating time was 212 minutes. Conversion rate was 2.6%. Overall morbidity rate was 21.1%. Anastomotic leakage occurred in 6.4%. Operative mortality rate was 0.3%. Mean number of harvested nodes was 23. Mean distal tumor-free margin was 2.8 cm. The circumferential resection margin was positive in 13 patients (4.2%). With a mean follow-up of 30 months in the stage I-III patients, the local recurrence rate was 2.9%. Systemic recurrence occurred in 11.7%. No port-site recurrence was observed. CONCLUSION: Laparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes. When considering a high volume of advanced and low-lying cancers but rather narrow indication to radiotherapy, the 2.9% local recurrence rate seems promising data. Long-term follow-up is mandatory to draw conclusion.