Laparoscopic-assisted right hemicolectomy in inflammatory versus noninflammatory conditions of the large bowel

Abstract

The most common indications for laparoscopic-assisted right hemicolectomy are terminal ileal Crohn's disease (TICD) and noninflammatory conditions such as polyps or cancer. While patients in the former category are usually younger and require immunosuppressive medications, patients in the latter category are older and may have significant comorbidity. The aim of this study was to compare and contrast the results of this operation performed on these two very different groups of patients. Between August 1991 and September 1998, 85 patients underwent laparoscopic-assisted right hemicolectomy. Statistical analysis was performed using Mann-Whithney test. A total of 31 patients (19 F / 12 M) of mean age 40 years (range, 15–74), were operated upon for TICD while 54 patients (22 F /32 M) of mean age 70 years (range, 30–87) (p<0.01) were operated upon for noninflammatory bowel disease (NIBD) including polyps (n=29), adenocarcinoma (n=19), and other reasons (n=6). In the TICD group, 18 were operated on for strictures, 3 for fistulas, 2 for abscesses, and 8 for two or more of these reasons. Overall there were 7 intraoperative complications reported: 4 in the TICD group and 3 in the NIBD group (p=70). The total operative time was 144 min (range, 90–260) in the TICD vs. 153 min (range, 70–270) in the NIBD group (p=0.40). Hospital stay was 6.4 days (range, 3–18) in the TICD group vs. 7.7 days (range, 3–19) in the NIBD group (p=0.0175). Six of the TICD patients and 6 of the NIBD patients had their procedure converted to laparotomy (p=0.34). In the TICD group, 12 patients (39%) had a total of 16 postoperative complications, 3 of which were wound related and 8 of which were general medical complications. One patient had an anastomotic leak while 4 patients had prolonged postoperative ileus. In the NIBD group, 23 (43%) patients had a total of 28 complications of which 7 were wound related; 11 patients had prolonged postoperative ileus and 10 were general medical complications (p=NS between groups). During a mean follow-up of 41 months (range, 3–89), 3 patients in the TICD group and 4 in the NIBD group developed incisional hernia. Despite the inflammatory nature of inflammatory bowel disease with related septic conditions such as fistulae and consequent abscesses, the overall operative complication rate was not significantly different from complication rates in patients with noninflammatory conditions. One factor contributing to this finding may be the younger age in the TICD group. Thus, laparoscopic right hemicolectomy can be safely performed for both inflammatory and noninflammatory conditions.