Hand-assisted Laparosocopic Surgery with Subtotal Colectomy for Colonic Inertia: Early Experiences in Tri-Service General Hospital

Abstract

Purpose. Subtotal colectomy and ileorectal anastomosis is the standard procedure for selected patients with slow transit constipation (STC). Today, minimally invasive approaches are being utilized in a greater number of procedures as surgeons become more familiar with the techniques involved. The aim of this study was to examine the results of hand-assisted laparoscopic surgery for subtotal colectomy in the treatment of patients with STC. Method. From January 2002 to January 2003, eight young females presented complaints of severe constipation for 2 years prior to admission. STC was diagnosed after a series of examinations including a colonic transit test, anal manometry, and barium enema. All patients underwent a hand-assisted laparoscopic subtotal colectomy and an ileorectal end-to-end anastomosis was performed using a circular stapling instrument. Outcome data analyzed included the operative time, conversion to open procedure, blood loss, time to return of flatus, length of postoperative hospital stay, and complications. Result. The mean operative time was 182.5 min (range, 150-220 min). The mean estimated blood loss was 172.5 mL (range, 100-220 mL). The mean days of first time to flatus was 2.5 days (rang, 2-3 days) and the mean hospital stay was 6 days (range, 5-7 days). These was no conversion to an open procedure and surgical mortality was zero. In the following period, only one case developed intestinal obstruction. A lyisi of adhesion was carried out for this case. Conclusion. Hand-assisted laparoscopic subtotal colectomy is a safe and feasible operation in the treatment of STC.