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05.11.2015 | Ausgabe 8/2016

Surgical Endoscopy 8/2016

Laparoscopic sigmoid colectomy: Are all laparoscopic techniques created equal?

Zeitschrift:
Surgical Endoscopy > Ausgabe 8/2016
Autoren:
Emily F. Midura, Dennis J. Hanseman, Bradley R. Davis, Bobby L. Johnson, Joshua W. Kuethe, Janice F. Rafferty, Ian M. Paquette
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-015-4654-3) contains supplementary material, which is available to authorized users.

Abstract

Background

Laparoscopic colectomy has been associated with improved postoperative pain control, earlier return to work, and shorter hospital stays compared to open colectomy. However, there are varied technical approaches to laparoscopic resections. We therefore sought to determine whether the straight laparoscopic approach was associated with shorter length of stay compared to hand-assisted and laparoscopic-assisted techniques for sigmoid colectomies.

Methods

A retrospective review of laparoscopic sigmoid colectomies performed by five colorectal surgeons from 2010 to 2014 was performed. Approaches were defined as: (1) straight laparoscopic if colon mobilization, inferior mesenteric artery transection and intra-corporeal anastomosis were performed laparoscopically, (2) hand assisted if a hand port was utilized to assist with mobilization and vessel transection, and (3) laparoscopic assisted if only the colon mobilization was performed intra-corporeally. Poisson regression was performed to determine the impact of surgical technique on LOS while controlling for differences in patient factors.

Results

A total of 191 patients were identified with 71 straight laparoscopic, 57 hand-assisted, and 63 laparoscopic-assisted cases. Substantial variability in choice of surgical technique was seen across surgeons. Patient populations were similar, with the exception of hand-assisted procedures being more often used in obese patients. Unadjusted average postoperative days to discharge were 3.6 days for straight laparoscopic and 4.1 and 4.0 days for hand-assisted and laparoscopic-assisted approaches, respectively. While controlling for factors associated with longer hospital stay, the straight laparoscopic approach was associated with a 14 % shorter stay compared to laparoscopic-assisted colectomy and a 15 % shorter stay compared to hand-assisted colectomy. The straight laparoscopic approach was also associated with earlier return of bowel function compared to other approaches.

Conclusions

The straight laparoscopic approach to sigmoid colectomy is associated with substantially shorter postoperative stay and earlier return of bowel function when compared to hand-assisted and laparoscopic-assisted techniques. When technically feasible, the straight laparoscopic approach is preferred.

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Zusatzmaterial
Supplementary material 1 (DOCX 47 kb)
464_2015_4654_MOESM1_ESM.docx
Literatur
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