Abstract
Background
Laparoscopic-assisted colon resection has been shown to result in earlier return of bowel function, decreased postoperative pain, decreased length of stay, and decreased morbidity when compared to open resection. Laparoscopic-assisted hemicolectomy often still involves externalization of the bowel for resection and anastomosis. The aim of this study was to determine short-term outcomes of performing intra- versus extracorporeal resection and anastomosis in laparoscopic-assisted hemicolectomy.
Methods
Retrospective chart review of 105 consecutive patients who underwent laparoscopic-assisted hemicolectomy or colectomy by a single surgeon from January 2006 through August 2008 was performed. Pearson χ2 and Student’s t test were used to test for significance.
Results
There were 105 patients in total who underwent laparoscopic-assisted ileocolic resection (66), right hemicolectomy (29), left hemicolectomy (9), and subtotal colectomy (1). There were more males in the extracorporeal group, but patients in the two groups were otherwise demographically comparable. An intracorporeal anastomosis was performed in 54 patients and extracorporeal in 51 patients. The operation was longer in the intracorporeal group (p ≤ 0.001), but estimated blood loss was less (p = 0.014). Postoperatively, there was no significant difference in time to bowel movement between the intra- and extracorporeal anastomosis groups; however, there was earlier return of flatus (2 vs. 2.4 days, respectively; p = 0.017). Postoperative narcotic use (16 vs. 49 mg morphine equivalents; p = 0.001), length of stay (3.2 vs. 3.8 days; p = 0.012), and perioperative morbidity (6 vs. 15 patients; p = 0.019) were all decreased in the intra- versus extracorporeal group, respectively. There was no perioperative mortality.
Conclusion
In comparison to the extracorporeal technique, resection and creation of the anastomosis intracorporeally produces superior results with earlier return of bowel function, decreased postoperative narcotic use, and decreased length of stay and morbidity. Further studies will be needed to verify our findings.
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References
Bilimoria KY, Bentrem DJ, Nelson H, Stryker SJ, Stewart AK, Soper NJ, Russell TR, Ko KY (2008) Use and outcomes of laparoscopic-assisted colectomy for cancer in the United States. Arch Surg 143:832–840
Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824
Kemp JA, Finlayson SRG (2008) Outcomes of laparoscopic and open colectomy: a national population-based comparison. Surg Innov 15:277–283
Kennedy GD, Heise C, Rajamanickam V, Harms B, Foley EF (2009) Laparoscopy decreases postoperative complication rates after abdominal colectomy. Ann Surg 249:596–601
Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taura P, Pique JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 359:2224–2229
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AMH, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial): multicenter, randomized controlled trial. Lancet 365:1718–1726
Colon Cancer Laparoscopic or Open Resection Study Group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 6:477–484
Transatlantic Laparoscopically Assisted vs Open Colectomy Trials Study Group (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303
Tong DKH, Fan JKM, Law W-L (2008) Outcome of laparoscopic colorectal resection. Surgeon 6:357–360
Colon Cancer Laparoscopic or Open Resection Study Group (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial. Lancet Oncol 10:44–52
Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy. Arch Surg 138:1179–1186
Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschieri A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL (2004) Laparoscopic resection of colon cancer. Surg Endosc 18:1163–1185
Schwenk W, Haase O, Neudecker JJ, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 2:CD003145. doi:10.1002/14651858.CD003145.pub2
Noel JK, Fahrback K, Estok R, Cella C, Frame D, Linz H, Cima RR, Dozois EJ, Senagore AJ (2007) Minimally invasive colorectal resection outcomes: short-term comparison with open procedures. J Am Coll Surg 204:291–305
Poon JT, Law W-L, Wong IW, Ching PT, Wong LW, Fan JKM, Lo OSH (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249:77–81
Duepree H-J, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181
Bernstein MA, Dawson JW, Reissman P, Weiss EG, Nogueras JJ, Wexner SD (1996) Is complete laparoscopic colectomy superior to laparoscopic assisted colectomy? Am Surg 62:507–511
Bergamaschi R, Teutch JJ, Pessaux P, Arnaud JP (2000) Intracorporeal vs laparoscopic-assisted resection for uncomplicated diverticulitis of the sigmoid. Surg Endosc 14:520–523
Aalbers AGJ, Biere SSAY, van Berge Henegouwen MI, Bemelman WA (2008) Hand-assisted or laparoscopic-assisted approach in colorectal surgery: a systematic review and meta-analysis. Surg Endosc 22:1769–1780
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Drs. Grams, Tong, Greenstein, and Salky have no conflicts of interest or financial ties to disclose.
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Grams, J., Tong, W., Greenstein, A.J. et al. Comparison of intracorporeal versus extracorporeal anastomosis in laparoscopic-assisted hemicolectomy. Surg Endosc 24, 1886–1891 (2010). https://doi.org/10.1007/s00464-009-0865-9
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DOI: https://doi.org/10.1007/s00464-009-0865-9