Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study.
BACKGROUND
Laparoscopic colonic surgery has been claimed to hasten recovery and reduce hospital stay compared with open operation. Recently, enforced multimodal rehabilitation (fast-track surgery) has improved recovery and reduced hospital stay in both laparoscopic and open colonic surgery. Since no comparative data between laparoscopic and open colonic resection with multimodal rehabilitation are available, the value of laparoscopy per se is unknown.


METHODS
In a randomized, observer-and-patient, blinded trial, 60 patients (median age 75 years) underwent elective laparoscopic or open colonic resection with fast-track rehabilitation and planned discharge after 48 hours. Functional recovery was assessed in detail during the first postoperative month.


RESULTS
Median postoperative hospital stay was 2 days in both groups, with early and similar recovery to normal activities as assessed by hours of mobilization per day, computerized monitoring of motor activity assessed, pulmonary function, cardiovascular response to treadmill exercise, pain, sleep quality, fatigue, and return to normal gastrointestinal function. There were no significant differences in postoperative morbidity, mortality, or readmissions, although 3 patients died in the open versus nil in the laparoscopic group.


CONCLUSIONS
Functional recovery after colonic resection is rapid with a multimodal rehabilitation regimen and without differences between open and laparoscopic operation. Further large-scale studies are required on potential differences in serious morbidity and mortality.
Basse
Linda
L
Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, DK-2650 Hvidovre, Denmark.
Jakobsen
Dorthe Hjort
DH
Bardram
Linda
L
Billesbølle
Per
P
Lund
Claus
C
Mogensen
Torben
T
Rosenberg
Jacob
J
Kehlet
Henrik
H
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011183:Postoperative Complications; D020127:Recovery of Function; D015656:Respiratory Mechanics
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