title: Right colectomy: value of the totally laparoscopic approach.
abstract: The role of laparoscopy for right colectomy remains controversial - largely because of a lack of standardization of the operative procedure, including a diversity of techniques including laparoscopy-assisted cases with extra-corporeal anastomosis and totally laparoscopic procedures with intra-corporeal anastomosis.
  
  
  METHODS
  The charts of all patients who underwent right colectomy by a totally laparoscopic approach in our service since 2004 were reviewed and pre-, intra-, and postoperative data were collected.
  
  
  RESULTS
  Eighty-two patients underwent totally laparoscopic right colectomy; of these, 32 had a BMI greater than 20 kg/m2 (39%). The mean operative duration was 113 minutes. In most cases, the operative specimen was extracted through a supra-pubic Pfannenstiel incision measuring 4-6 cm in length. Three cases were converted to a laparoscopy-assisted technique (in order to control the ileo-cecal vascular pedicle because of extensive nodal invasion in two cases, and to evaluate a hepatic flexure polyp in the third case). Overall morbidity was 29.3% and parietal morbidity was only 9.8%; there was no difference in morbidity between obese patients (BMI>30 kg/m2) and non-obese patients (BMI<30 kg/m2). The mean duration of hospitalization was 9 days and two patients developed ventral hernia in the extraction incision in long-term follow-up.
  
  
  CONCLUSIONS
  These satisfactory results show that the totally laparoscopic approach to right colectomy is technically feasible and safe, even in obese patients. In addition, the very low rate of parietal complications is an argument in favor of this approach.
authors.affiliation: Unité des maladies de l'appareil digestif et endocrine, centre hospitalier de Luxembourg, 4, rue Barblé, 1210 Luxembourg, Luxembourg. olivierfacy@yahoo.fr
authors.forename: O
authors.initials: O
authors.lastname: Facy
authors.forename: L
authors.initials: L
authors.lastname: De Magistris
authors.forename: V
authors.initials: V
authors.lastname: Poulain
authors.forename: M
authors.initials: M
authors.lastname: Goergen
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.forename: J-S
authors.initials: JS
authors.lastname: Azagra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003082:Colectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D003110:Colonic Neoplasms / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008189:Luxembourg / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology
keywords: Intra-corporeal anastomosis; Laparoscopy; Right colectomy