Longterm complications of hand-assisted versus laparoscopic colectomy.
BACKGROUND
Hand-assisted laparoscopic surgery (HALS) requires a larger incision compared with standard laparoscopic surgery (SLS). Whether this leads to more longterm complications, such as incisional hernia (IH) and small bowel obstruction (SBO), has not been studied to date. This study compares the rates of SBO and IH after HALS and SLS in patients undergoing operations for colon and rectal diseases.


METHODS
From a colorectal database, 536 consecutive patients were identified who underwent bowel resection using HALS (n = 266) and SLS (n = 270) between 2001 to 2006. All medical records were reviewed, and all subjects were contacted by telephone for accurate followup. Statistical analysis was performed using chi-square, Fisher's exact, and Mann-Whitney U tests, where appropriate.


RESULTS
Median followup was 27 months (range 1 to 72 months). Overall conversion rate was 2.2% (SLS, n = 4; HALS, n = 8). Median incision size in HALS (75 mm; range 60 to 140 mm) was larger than SLS (45 mm; range 30 to 130 mm; p < 0.01). Despite the larger wound, the incidence of IH was similar between both approaches (HALS, n = 16 [6.0%] versus SLS, n = 13 [4.8%]; p < 0.54). Rate of SBO was also comparable (HALS, n = 11 [4.1%] versus SLS, n = 20 [7.4%]; p = 0.11). Wound infections occurred similarly between both groups (HALS, n = 18 [6.8%]; SLS, n = 13 [4.8%]; p = 0.33). Converted patients had a higher rate of IH compared with nonconverted ones (25% versus 5%; p = 0.02), although the rate of SBO was similar (8.3% versus 5.7%; p = 0.51).


CONCLUSIONS
HALS does not lead to more longterm complications of IH and SBO when compared with SLS for resections of the colon and rectum.
Sonoda
Toyooki
T
Section of Colon and Rectal Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Pandey
Sushil
S
Trencheva
Koiana
K
Lee
Sang
S
Milsom
Jeffrey
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects*; D005260:Female; D006555:Hernia, Ventral / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery*; D007415:Intestinal Obstruction / Q000453:epidemiology* / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult