Laparoscopic-assisted colon resection. Evolution from an experimental technique to a standardized surgical procedure.
Between October 1991 and November 1992, 51 patients in the mean age 63.2 years (range 19 to 91 years) underwent laparoscopic colon resection. Indications for surgery were colon carcinoma (31), adenomatous polyps (8), diverticulitis (10) and Crohn's disease (2). In right-sided lesions an extracorporeal anastomosis and in left-sided lesions an intracorporeal anastomosis was performed using the double stapling technique. The mortality rate was 1.9% and the morbidity rate 20.5% in the laparoscopic-treated group. The conversion rate was 13.7%. Except for one anastomotic leakage in a converted patient, no anastomotic problems were encountered. The percentage of infectious complications was 11.7%. Three reinterventions were necessary for treatment of two deep subfascial abscesses and one case of localized peritonitis, caused by a small small bowel injury. The mean hospital stay was 9.1 days (range 4-29 days). In the last 13 consecutive patients, except for a urinary infection, no further post-operative morbidity was encountered. Laparoscopic-assisted colon resection has evolved in to a standardized surgical technique. Initial learning problems are solved by good patient selection, better operative logistics and awareness of the dangers and pitfalls of laparoscopic surgery.
Jansen
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St. Antonius Hospital, Nieuwegein, The Netherlands.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000295:instrumentation / Q000639:trends; D003108:Colonic Diseases / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D013525:Surgical Instruments; D016896:Treatment Outcome