Laparoscopic total abdominal colectomy. A prospective trial.
The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included the length of surgery, length of ileus, length of hospitalization, morbidity, and mortality. Five patients underwent standard TAC (Group I), and five underwent L-TAC (Group II). Group I consisted of five patients of a mean age of 32 (range, 24-51) years who had mucosal ulcerative colitis (n = 1), familial adenomatous polyposis (n = 3), or colonic inertia (n = 1). Group II consisted of five patients of a mean age of 33 (range, 17-43) years who had mucosal ulcerative colitis (n = 1), familial adenomatous polyposis (n = 3), or colonic inertia (n = 1). This preliminary prospective study indicates that laparoscopically assisted TAC is feasible. L-TAC resulted in a slightly longer length of ileus and length of hospitalization; these differences were not statistically significant. Moreover, the length of time required for the laparoscopic procedures was 35 percent longer than for the open procedures. Although these results may improve as more cases are performed, dramatic differences in rates of postoperative recovery have not yet been realized. In conclusion, L-TAC, while technically feasible, dose not appear to offer any immediately recognizable benefits to the patient as compared with standard laparotomy.
Wexner
S D
SD
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309.
Johansen
O B
OB
Nogueras
J J
JJ
Jagelman
D G
DG
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D003082:Colectomy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D013997:Time Factors