The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn's colitis.
BACKGROUND
Hand-assisted laparoscopic surgery (HALS) has gained wide clinical acceptance as a practical alternative to laparoscopically assisted surgery (LAP) for the surgical treatment of complex colorectal diseases (e.g., ulcerative colitis and diverticulitis). However, its role in the further challenging operation for Crohn's colitis (i.e., subtotal or total colectomy) has yet to be established. This study aimed to evaluate the feasibility, safety, and potential benefit of HALS subtotal and total colectomy for Crohn's colitis.


METHODS
The study reviewed 38 consecutive patients who underwent subtotal or total colectomy as their initial abdominal surgery for Crohn's extensive colitis (involvement of 3 or more colonic segments) between 1992 and 2006. The patients were divided into three groups (open, LAP, and HALS), and their background and postoperative data were retrospectively analyzed.


RESULTS
The reviews included 14 open, 6 LAP, and 18 HALS cases. The groups were comparable in terms of age at surgery, gender, body mass index, extent and type of disease, indications, and procedures. The median operative time was significantly longer for LAP (330 min; range, 154-540 min) than for HALS (251 min; range, 165-340 min) or open surgery (200 min; range, 172-315 min). The blood loss was significantly less with LAP (170 ml; range, 115-257 ml) and HALS (225 ml; range, 35-890 ml) than with open surgery (438 ml; range, 280-780 ml). No difference was seen in postoperative complications, and no mortality occurred in the series.


CONCLUSIONS
The findings showed that HALS subtotal and total colectomies are feasible and safe. The HALS procedure currently seems potentially beneficial for patients with extensive Crohn's colitis by reducing the operative time for laparoscopic surgery while retaining its less invasiveness.
Nakajima
Kiyokazu
K
Department of Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. knakajima@gesurg.med.osaka-u.ac.jp
Nezu
Riichiro
R
Hirota
Masaki
M
Nishida
Toshirou
T
D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000379:methods; D003092:Colitis / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult