The Clinical Presentation of Anastomotic Leakage Compared Between CRS-HIPEC and Conventional Colorectal Surgery

This study was designed to evaluate the influence of intraoperative intermittent sequential compression (ISC) on venous blood return from the lower limbs during laparoscopic and conventional colorectal colectomy. Fifty patients undergoing laparoscopic (n = 25) or conventional (n = 25) colorectal surgery were included in a prospective study. Peak venous flow (PFV) and the cross-sectional area (CSA) of the femoral vein were assessed by Doppler ultrasound examination intraoperatively. Age, gender, and body mass index were comparable between both groups. Baseline PFV was 21 +/- 6.6 cm/s in the conventional and 18.4 +/- 6.4 cm/s in the laparoscopic group (P = 0.2). ISC increased PFV to 156 +/- 29 percent of the baseline value in the conventional group and to 161 +/- 29 percent in the laparoscopic group. PFV decreased after abdominal insufflation to 127 +/- 19 percent of the baseline value in the laparoscopic group and after laparotomy to 134 +/- 27 percent in the conventional group (P = 0.3). PFV decreased slightly in both groups during surgery but remained well above the baseline value. Baseline CSA was 1.02 +/- 0.17 cm2 in the conventional group and 1 +/- 0.23 cm2 in the laparoscopic group. ISC decreased CSA to 0.91 +/- 0.18 cm2 (conventional) and 0.85 +/- 0.18 cm2 (laparoscopic) after initiation of ISC. CSA was 0.92 +/- 0.18 cm2 after abdominal insufflation in the laparoscopic group, and it was 0.93 +/- 0.18 cm2 after laparotomy in the conventional group (P = 0.4). During surgery, there were no differences in absolute CSA or CSA changes compared with the baseline value in both groups. Postoperative circumference of the calf and thigh were not different between both groups. Postoperative thromboembolic complications did not occur. ISC effectively increases venous blood flow from the lower limbs during conventional and laparoscopic colorectal resections and may decrease the risk of postoperative deep vein thrombosis. Therefore, ISC is strongly recommended in every prolonged laparoscopic procedure.

The outcomes of laparosopic and conventional colorectal surgery, with special reference to costs of treatment and patients' quality of life, were compared. A partly retrospective cohort study was designed to assess the use of resources, and a follow-up interview was undertaken to evaluate patients' quality of life after both to define laparoscopic (LAP) and conventional (CON) surgery. The length of hospital stay was significantly lower in the LAP group (median, 11 days; interquartile range [IQR], 9-15) than in the CON group (median, 16 days; IQR, 13-23; p < 0.0001), which is reflected in lower costs of hospitalization calculated for the three most frequent surgical interventions. Statistically significant improvements were noted between the median scores in the domains of physical functioning (LAP 85 vs CON 68; p < 0.05) and vitality (LAP 85 vs CON 69; p < 0.05). Laparoscopy is a promising alternative for the treatment of patients with colorectal diseases, offering lower costs and a better quality of life in the long term.

Cellular and humoral inflammatory response after laparoscopic and conventional colorectal surgery

Complications of Laparoscopic Colorectal Surgery in Considering the Anastomotic Insufficiency Rate. Literature Review and Results of the Multicenter Study ''Laparoscopic Colorectal Surgery'' Currently, about 5% of all colorectal operations in German-speaking countries are carried out with the laparoscopic modality. The most common of these interventions is resection of the sigmoid colon. In terms of postoperative morbidity, the minimally invasive approach has been found to be of advantage. In the case of operations for colorectal carcinoma, however, laparoscopic interventions continue to provoke controversial discussion. Patients being considered for a laparoscopic intervention first have to meet comparatively strict general and oncological selection criteria. The literature reports global morbidity rates of up to 60% for conventional, and up to 40% for laparoscopic, colorectal surgery. For conventional colorectal surgery, the anastomotic insufficiency rates for colon and upper rectum reported in the literature are up to 9%, with appreciably higher rates associated with the lower rectum. Studies on laparoscopic colorectal surgery identify anastomotic insufficiency rates of up to 7.5%, again with higher rates being reported for the low rectal anastomoses. Within the study group `Laparoscopic Colorectal Surgery'', an intra-operative complication rate of 5.5% and a global postoperative complication rate of 21.6% were found. The conversion rate was 5.3%, the anastomotic insufficiency rate 4.1%, the overall mortality rate 1.6%. When the appropriate selection criteria are applied, laparoscopic colorectal interventions are associated with a low postoperative morbidity rate, similar to, or lower than, that achieved with conventional colorectal surgery. Against this background, the feasibility and safety of laparoscopic colorectal anastomoses can be considered to have been unequivocally demonstrated. Currently, however, laparoscopic procedures cannot be considered the gold standard of colorectal surgery, since oncological considerations in particular render this operative modality inaccessible to the majority of patients.

Laparoscopic colorectal surgery had a somewhat difficult evolution. It is technically difficult, with a broad field of mobilization requiring multiple careful prot placement, need to deal with major vascular pedicles and the handling of larger surgical specimens. Aim of the present study is to make a comparison between laparoscopic and conventional colorectal surgery of cancer.

Transanal one-stage endorectal pull-through for Hirschsprung's disease in infants and children

Laparoscopy has become a popular approach for the surgical treatment of benign and even malignant colorectal diseases. Several authors have reported better preserved immunity in patients undergoing laparoscopic compared with conventional colorectal surgery. The present study addresses the hypothesis that specific and nonspecific immunity are differently affected by laparoscopic and conventional colorectal surgery. Nonrandomized control trial. University hospital. Seventy prospectively enrolled patients with colorectal diseases undergoing laparoscopic (n = 35) or open (n = 35) surgery. Blood samples were taken prior to surgery as well as on days 1, 3, and 5 after surgery. Cell numbers of lymphocyte subpopulations as well as natural killer cells were determined by flow cytometry, and interleukin 6 and C-reactive protein serum levels were measured. Significant differences between study and control patients (P<.05) were detected regarding circulating interleukin 6 and C-reactive protein levels with a reduced proinflammatory response to surgery in patients after laparoscopic surgery. Furthermore, postoperative natural killer cell counts were significantly higher in patients after laparoscopic surgery. The levels of B lymphocytes and T lymphocytes and helper T-cell counts and cytotoxic (suppressor) T-cell counts did not show significant differences after open or laparoscopic surgery. Our findings indicate a less pronounced proinflammatory response to surgical trauma in patients after minimally invasive surgery. The nonspecific immune response appears to be less affected by laparoscopic surgery when compared with open surgery while the specific cell-mediated immunity is equally affected. These findings are important because a divergent effect on specific and nonspecific immunity of laparoscopic surgery for colorectal disease has not been reported before.

This study was designed to compare outcomes after elective laparoscopic and conventional colorectal surgery over a ten-year period using data from the English National Health Service Hospital Episode Statistics database. All elective colonic and rectal resections carried out in English Trusts between 1996 and 2006 were included. Univariate and multivariate analyses were used to compare 30 and 365-day mortality rates, 28-day readmission rates, and length of stay between laparoscopic and open surgery. Between the study dates 3,709 of 192,620 (1.9%) elective colonic and rectal resections were classified as laparoscopically assisted procedures. The 30-day and 365-day mortality rates were lower after laparoscopic resection than after open surgery (P < 0.05). After correction for age, gender, diagnosis, operation type, comorbidity, and social deprivation, laparoscopic surgery was a strong determinant of reduced 30-day (odds ratio, 0.57; 95% confidence interval, 0.44-0.74; P < 0.001) and one-year (odds ratio, 0.53; 95% confidence interval, 0.42-0.67; P < 0.001) mortality. Similarly, multivariate analysis confirmed that laparoscopic surgery was independently associated with reduced hospital stay (P < 0.001). Patients who received rectal procedures for malignancy, however, were more likely to be readmitted if laparoscopy rather than by a traditional method was used (11.9% vs. 9.1%, P = 0.003). In the present study, patients selected for laparoscopic colorectal surgery were associated with reduced postoperative mortality when compared with those undergoing the conventional technique. This finding merits further investigation.

Background: An ERAS protocol is a set of guidelines to improve perioperative care. Its application in conventional colorectal surgery should be considered the new standard; its advantages in laparoscopic surgery are discussed. Objectives: To evaluate the applicability of ERAS in laparoscopic colorectal surgery. Secondary objective: comparative analysis of early results. Setting: Hospital Britanico de Buenos Aires (British Hospital of Buenos Aires). Design: Retrospective. Population: 35 patients operated on by laparoscopy within the ERAS protocol (A), compared to a similar control group (B), outside the ERAS protocol. Period: March 2011 to August 2012. Method: the applicability of all steps of the protocol was evaluated. The variables compared were fluid management, tolerance of diet, intestinal transit, length of hospital stay, complications, mortality and readmission rate. Results: Group A: 8.57% referred not to have fully understood the protocol, 25.71% did not meet preoperative indications. 28.5% had no epidural catheter. 80% of patients received adequate hydration. 43% did not ingest the preparation of carbohydrates. 80% received early feeding; mobilisation was delayed in 28.5%. Intraoperative fluid infusion in group A was significantly lower than in controls. Group A tolerated liquids and solids earlier than controls. In group B, one more litre of parenteral hydration was used during hospitalisation. Passage of stool occurred earlier in group A than in controls. Overall morbidity was not significant. The length of stay was significantly lower in group A. Readmission was similar. There was no mortality. Conclusion: It is possible and safe to apply an ERAS protocol in laparoscopic colectomy with an acceptable compliance in our hospital, with a faster discharge and the same rate of readmissions.

Our aim here was interpret data on the perioperative course, oncological quality, and preliminary long-term results of laparoscopic colorectal surgery carried out with a curative intent. The data were collected within the framework of a prospective multicenter observational study that has been ongoing since 1 Aug 1995 and includes 46 hospitals. Of a total of 3133 patients, 826 (26.4%) underwent a curative resection for colorectal carcinoma. The average age of the patients was 67.9 years; the sex distribution was almost 1:1. UICC staging of tumors (stages I, II, and III) showed the following figures: 301/36.4%, 265/32.1%, and 260/31.5%. In the majority of cases, an oncologically radical resection with high transection of the supplying vessels was performed. Intraoperative seeding of tumor cells was reported in 1.8% of the patients. In eight cases, the seeding was due to spontaneous rupture of the tumor. A mean of 13.5 lymph nodes in the resected specimen were investigated histopathologically (10.9 lymph nodes in stage I, 15 each in stages II and III). Depending on the individual hospital, we found a remarkable variation in the number of lymph nodes investigated. With a mean follow-up period of 2.1 years, Kaplan-Meier survival function showed acceptable results, both for rectal and colonic carcinoma, in comparison with conventional colorectal surgery. A stage-related consideration of the survival data yielded similar results. All in all, the results show that a laparoscopic colorectal procedure can meet oncological radicality criteria, even though certain reservations-in particular, in the case of procedures done with a curative intent-have not been completely eliminated.

The first laparoscopic colorectal surgery was performed in 1991. Several reports have showed some advantages for the laparoscopic technique compared to open procedures, but the lack of well designed trials has produced doubts about the real advantage of laparoscopy for colorectal cancer. To date, retrospective and prospective evidence suggests that laparoscopy is as safe as conventional colorectal surgery. Two recent prospective, randomized trials have showed that the short-term outcome is not compromised after laparoscopy for colorectal cancer. Furthermore, less pain, faster recovery of respiratory parameters, and better preservation of cell-mediated immune function have been associated with the laparoscopic technique. Laparoscopic surgery for early colorectal cancer may have a role in a well selected group of patients.

Comparison of resource utilization and long-term quality-of-life outcomes between laparoscopic and conventional colorectal surgery

Significant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. The advantages of the laparoscopic procedures, such as shorter hospital stay, lower bleeding and better cosmesis were also noticed in resections for CD. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. This is a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012, with laparoscopic surgery (LS) or conventional surgery (CS). A review of electronic charts was performed, with a specific protocol. Variables analyzed: age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Complications were defined as medical (urinary tract infection, pneumonia, ileus, pancreatitis and central venous catheter infection) or surgical (abdominal abscess, fistula, anastomotic leakage and wound infection). Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LS or CS), and complication rates and characteristics were compared. Statistical analysis was performed with Mann Whitney test (quantitative variables) and chi-square test (qualitative variables), with P < 0.05 considered significant. A total of 46 patients (25 men) were included (16 submitted to laparoscopic surgery), with mean age of 38.1 (±12,7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CS group (P = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CS and 75% of the LS patients - P = 0.566). Overall, total complications (surgical and medical, including minor and major issues) occurred in 60% (18/30) of the CS group and 12,5% (2/16) of the LS group (P = 0.002). Wound infection was the most frequent complication (10/30 on CS and 1/16 on the LS groups). There were 3 deaths in the CS group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (P = 0.074). There was a higher complication rate in patients operated with CS as compared to LS. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. Randomized controlled trials can lead to better conclusions regarding this topic. However, LS tends to be the recommended approach in most cases of non-complicated CD.

This study evaluated the feasibility and safety of laparoscopic bowel surgery performed by colorectal surgeons not previously experienced in laparoscopic biliary or appendiceal surgery. Thirty-two patients underwent ileocolic resection/anastomosis (n = 12), loop ileostomy (n = 7), colostomy (n = 4), ileostomy takedown/ileorectal anastomosis (n = 3), subtotal colectomy/ileorectal anastomosis (n = 2), sigmoid resection (n = 2), or other procedures (n = 2). No curative cancer surgery was undertaken. Time to first bowel movement was one to eight (median, four) days. Length of stay ranged from 4 to 11 (median, 6) days. There were no major complications seen in follow-up from 6 to 15 (median, 7) months after surgery. Large intestinal and distal ileal surgery using laparoscopic techniques, performed by surgeons with training only in laparoscopic intestinal surgery, is feasible and safe. Faster recovery and need for less postoperative analgesia in laparoscopic surgery compared with conventional surgery cannot be surmised from this study. A randomized study design is needed to evaluate many of the differences between conventional and laparoscopic intestinal surgery.

Anastomotic leakage (AL) is a major complication in colorectal surgery, particularly following rectal cancer surgery, necessitating effective prevention strategies. The increasing frequency of colorectal resections and anastomoses during cytoreductive surgery (CRS) for peritoneal carcinomatosis further complicates this issue owing to the diverse patient populations with varied tumor distributions and surgical complexities. This study aims to assess and compare AL incidence and associated risk factors across conventional colorectal cancer surgery (CRC), gastrointestinal CRS (GI-CRS), and ovarian CRS (OC-CRS), with a secondary focus on evaluating the role of protective ostomies. A retrospective analysis was performed on 1324 patients undergoing CRC, GI-CRS, and OC-CRS between January 2015 and December 2022. Multivariate analysis was utilized to identify preoperative, intraoperative, and postoperative variables as potential AL risk factors. The overall AL rate was 3.0% (40/1324), with no significant differences among the three groups. Distinct risk factors were identified for each group: CRC (preoperative chemoradiotherapy), GI-CRS (ECOG score ≥ 2, preoperative albumin < 30mg/dL), and OC-CRS (BMI < 18kg/m2, pelvic lymphadenectomy, preoperative albumin < 30mg/dL, anastomosis distance < 10cm, postoperative anemia). Protective ostomies did not reduce AL incidence, and a notable discrepancy exists between AL risk factors and those influencing protective ostomy decisions. AL, while rare, remains a serious postoperative complication in CRC and CRS. Key risk factors include preoperative nutritional status and surgical details such as blood supply and anastomosis level. Each patient group presents unique risks, which must be carefully weighed when considering protective ileostomy.