Superior nitrogen balance after laparoscopic-assisted colectomy.
BACKGROUND
Although early resumption of enteral feeding after gastrointestinal surgery results in improved nitrogen balance and lower infectious complications, no postoperative nutritional data after laparoscopic-assisted colectomy exists.


OBJECTIVE
The authors prospectively compared nitrogen balance after laparoscopic-assisted colectomy versus open colectomy.


METHODS
This is a series of colon resections (open, N = 10; laparoscopic-assisted, N = 9) at the Ferguson-Blodgett Hospital, Grand Rapids, Michigan, between January and March 1993. Nitrogen intake and 24-hour urine collections were performed on postoperative days 1, 3, and 7 for the analysis of total urinary nitrogen and urinary 3 methylhistidine-(3mH).


RESULTS
The time to passage of flatus (4.7 +/- 0.6; 2.0 +/- 0.2), resumption of oral intake (6.1 +/- 0.7; 1.4 +/- 0.2; p < 0.05, Student's test), first bowel movement (5.2 +/- 1.0; 3.0 +/- 0.3; p < 0.05, Student;s t test), and discharge (10.3 +/- 1.3; 4.1 +/- 1.8; p < 0.05, Student's t test) occurred significantly earlier in the laparoscopic-assisted colectomy group. Overall hospital charges were lower in the laparoscopic-assisted colectomy group ($11,572 +/- $823 vs. $13,961 +/- $1050). The operative time was higher in the laparoscopic-assisted colectomy group (176 +/- 12 hours vs. 105 +/- 17 hours, p < 0.05,Student's test). Blood loss was higher in the open group (805 +/- 264 mL vs 217 +/- 32 mL, p < 0.05, Student's test). Urinary nitrogen losses were similar between the two groups; however, significantly more patients in the laparoscopic-assisted colectomy group achieved net positive nitrogen on day 3 (6/9; 0/10; p < 0.05, Fisher's exact test), and day 7 (9/9; 4/10; p < 0.05, Fisher's exact test). Infectious complications occurred less frequently in the laparoscopic-assisted colectomy group (0/9 vs. 4/10; p < 0.05, Fisher's exact test).


CONCLUSIONS
Patients undergoing laparoscopic-assisted colectomy can achieve early resumption of enteral nutrition with earlier return to positive nitrogen balance compared with open colectomy. This may offer benefits of fewer infectious complications and lower cost of care.
Ferguson-Blodgett Digestive Disease Institute, Grand Rapids, Michigan.
A J
AJ
Senagore
M J
MJ
Kilbride
M A
MA
Luchtefeld
J M
JM
MacKeigan
A T
AT
Davis
J D
JD
Moore
D003082:Colectomy / Q000191:economics / Q000379:methods*; D004750:Enteral Nutrition; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008762:Methylhistidines / Q000652:urine; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D013997:Time Factors
D008762:Methylhistidines; C028118:3-methylhistidine; D009584:Nitrogen