Higher Rate Of Intraoperative Complications Research Articles

The Impact of Laparoscopic Converted to Open Colectomy on Short-Term and Oncologic Outcomes for Colon Cancer

PurposeThis study was designed to evaluate the impact of laparoscopic converted to open colectomy on short-term and oncologic outcomes and to identify risk factors for long-term survival in patients undergoing colectomy for non-metastatic colon cancer. MethodsA prospective database of consecutive operations for non-metastatic colon cancer was reviewed. Patients were grouped as conversion (CONV) group, completed laparoscopic resection (LAP) group, or open resection (OPEN) group. The clinical and perioperative parameters, pathologic features, and oncologic outcomes were collected. Univariate analysis was performed for comparing these data. Patients without evidence of recurrence at last follow-up or still alive at the end of study period were censored. Kaplan-Meier curves were utilized to analyze survival. A multivariate analysis was performed to identify predictors of poor disease-free survival (DFS) and overall survival (OS). ResultsThe conversion rate was 15.2 %. The most common reason for conversion was locally advanced cancer (45.5 %). Converted patients were associated with a longer operative time (188 ± 29.1 min, P < 0.001), greater blood loss (147 ± 14 mL, P < 0.001), and a higher rate of intra-operative complications (15.2 %, P = 0.042) compared to the completely laparoscopic or open patients. Days to flatus, early ambulation, and length of hospitalization were significantly shorter in completed laparoscopic resection (LAP) group (P < 0.001); however, the outcomes were comparable between conversion (CONV) and open resection (OPEN) groups. The incidence of wound infection was significantly higher in the OPEN group than in the LAP group (P = 0.005), whereas there were no significant differences observed between the CONV group and the OPEN group (P = 1.000) or between the LAP group and the CONV group (P = 0.073). The 5-year DFS in CONV patients (46.5 %) was comparable to LAP patients (55.5 %, P = 0.138) and OPEN patients (59.1 %, P = 0.113). Moreover, there were no significant differences noted in terms of the 5-year OS in the CONV group (56.7 %) compared to the LAP group (67.3 %, P = 0.317) or the OPEN group (66.3 %, P = 0.420). The multivariate analysis showed that pT3–4 cancer (P < 0.001) and poor differentiation (P < 0.001) were independent predictors of both lower OS and lower DFS, whereas leakage (P = 0.008) and lack of adjuvant chemotherapy (P = 0.023) were independent risk factors only of lower DFS. ConclusionConversion to open colectomy from an initial laparoscopic approach does not worsen the long-term survival in patients with non-metastatic colon cancer.

Colorectal cancer surgery remains effective with rising patient age.

BackgroundThe incidence of colorectal cancer rises disproportionally in aging persons. With a shift towards higher population age in general, an increasing number of older patients require adequate treatment. This study aims to investigate differences between young and elderly patients who undergo resection for colorectal cancer, regarding clinical characteristics, morbidity, and prognosis.MethodsBy retrospective analysis of 6 years (2007 to 2012) of a prospectively documented database, a total of 636 patients were identified who underwent oncological resection for colorectal cancer at our institution. Of this total, all 569 patients with primary colorectal adenocarcinoma were included. Four hundred ten patients were 74 years or younger and 159 were 75 years or older. The median follow-up was 22 months.ResultsOlder patients had significantly more comorbidities (85 % vs. 56 %, p < 0.001) and a higher ASA score (p < 0.001). The mean length of stay in the hospital was longer (24 vs. 20 days, p = 0.002), as was the length of postoperative intensive care stay (4 vs. 2 days, p = 0.003). However, elderly patients did not have significantly higher rates of intraoperative complications or surgical morbidity. Tumor-specific 2-year survival was 83 ± 4 % for the elderly and 87 ± 2 % for the younger patients, which was not significantly different (p = 0.90).ConclusionsLong-term outcome after oncologic resection for colorectal cancer does not differ between elderly and younger patients. Age in general should not be considered as a limiting factor for colorectal cancer surgery or tumor-specific prognosis.

Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse.

Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS. RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges. Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications. The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intra-operative complications.

Comparison of Perioperative Complications by Route of Hysterectomy Performed for Benign Conditions

Comparison of Perioperative Complications by Route of Hysterectomy Performed for Benign Conditions

Comparison between butterfly gastroplasty (a new modified gastroplasty technique) and sleeve gastrectomy

Background: Vertical banded gastroplasty (VBG) and sleeve gastrectomy(SG) are purely gastric restrictive procedures designed to reduce appetite by decreasing the size of the stomach. Butterfly gastroplasty, is a modification of (VBG) in which a micro funnel shaped pouch was constructed limited to cardia in order to reduce the risk oflong-term staple-line disruption. This study presents preliminary results of our early experience with both procedures. Methods: From August 2010 till August 2012 (60) consecutive patients with morbid obesity (9 males and 51 females) divided into two groups, (group 1) underwent laparoscopic butterfly gastroplasty (30 patients) and (group 2) underwent laparoscopic sleeve gastrectomy (30 patients). This study aimed to compare the preliminary results of both procedures including operative morbidity and mortality, short and long-term complications, as well as follow-up rates and parameters of weight loss. Results: There were 6/30 (20%) and 3/30 (10%) cases with intra-abdominal bleeding in butterfly gastroplasty and sleeve gastrectomy groups respectively. In butterfly gastroplasty group, one (1130) early complication (3.3%) was encountered, late complications occurred in one (1130) patient (3.3%) with no mortality occurred; two patients had persistant vomiting. In sleeve gastrectomy group, two (2130) early complications (6.7%) (leakage arising from stable line of the stomach) were encountered with no late complications or mortality occurred. Substantial weight loss occurred in all patients. For butterfly gastroplasty group mean excess weight loss (EWL %) was 41.99±6.17 % at 6 month and 64.02±5.16% at 1 year, while for sleeve gastrectomy EWL% was 41.12±3.7 % at 6 month and 53.85±5.44% at 1 year. The rate of complete resolution of co-morbidities in butterfly gastroplasty was 100% for hypertension at 6 month and diabetes mellitus at 12 month, while in sleeve gastrectomy group resolution of hypertension was 90.9% and diabetes mellitus was 92.6% at 12 month Conclusion: Butterfly gastroplasty and sleeve gastrectomy are feasible and safe restrictive bariatric procedures, with good short-term results and low morbidity rates. In comparison to sleeve gastrectomy, Butterfly gastroplasty has higher intra-operative complication rate (in the form ofbleeding), however it has also higher percentage of postoperative excess weight loss as well as reduction of assoiated preoperative morbidities.

COMPARISON OF INTRAOPERATIVE COMPLICATIONS OF PHACOEMULSIFICATION BETWEEN SEQUENTIAL AND COMBINED PROCEDURES OF PARS PLANA VITRECTOMY AND CATARACT SURGERY

To compare intraoperative complications during phacoemulsification between sequential and combined procedures of vitrectomy and cataract surgery. We retrospectively reviewed the medical records of 54 patients who underwent cataract surgery in a previously vitrectomized eye (sequential group) and 311 patients who underwent combined vitrectomy and cataract surgery (combined group). Primary outcome measures were intraoperative complications during phacoemulsification. Secondary measures were preoperative and intraoperative cataract gradings. The most common complication during phacoemulsification was posterior capsule rupture. The rate of posterior capsule rupture was higher in the sequential group (6 eyes, 11.4%) than in the combined group (14 eyes 4.5%, P = 0.049). Preoperative lens density (nuclear color and posterior subcapsular scores) was higher in the sequential group (P < 0.001). Intraoperative nuclear grading was higher compared with the preoperative one in the sequential group, but the two gradings did not differ in the combined group. Phacoemulsification in a vitrectomized eye is associated with a higher rate of posterior capsule rupture than the one in combined vitrectomy. These results may have been caused by hard nucleus cataract in a vitrectomized eye.

TAPP or TEP? Population‐Based Analysis of Prospective Data on 4,552 Patients Undergoing Endoscopic Inguinal Hernia Repair

Whether total extraperitoneal inguinal hernia repair (TEP) is associated with worse outcomes than transabdominal preperitoneal inguinal hernia repair (TAPP) continues to be a matter of debate. The objective of this large cohort study is to compare outcomes between patients undergoing TEP or TAPP. Based on prospective data of the Swiss association of laparoscopic and thoracoscopic surgery, all patients undergoing unilateral TEP or TAPP between 1995 and 2006 were included. The following outcomes were compared: conversion rates, intraoperative and postoperative complications, duration of operation. Data on 4,552 patients undergoing TEP (n=3,457) and TAPP (n=1,095) were collected prospectively. Average age and American Society of Anesthesiologists score were similar in the two groups. Patients undergoing TEP had a significantly higher rate of intraoperative complications (TEP 1.9% vs. TAPP 0.9%, p=0.029) and surgical postoperative complications (TEP: 2.3% vs. TAPP: 0.8%, p=0.003). The postoperative length of stay was longer for patients undergoing TAPP (2.9 vs. 2.3 days, p=0.002), whereas the duration of the operation was longer for TEP (66.6 vs. 59.0 min, p<0.001) and the conversion rate was higher (TEP 1.0% vs. TAPP 0.2%, p=0.011). This study is one of the first population-based analyses comparing TEP and TAPP in a prospective cohort of more than 4,500 patients. Intraoperative and surgical postoperative complications were significantly higher in patients undergoing TEP. TEP is also associated with longer operating times and higher conversion rates. Therefore, on a population-based level, the TAPP technique appears to be superior to the TEP repair in patients undergoing unilateral inguinal hernia repair.

Different approaches for complete mobilization of the splenic flexure during laparoscopic rectal cancer resection

Laparoscopic resection of rectal cancer has already become the standard procedure in many hospitals. The splenic flexure mobilization (SFM) is an important preparational step. Several methods are used for laparoscopic SFM; however, studies comparing different approaches are lacking. In the present study, three different approaches for SFM have been compared to each other. Between January 1998 and December 2010, 415 patients with rectal adenocarcinoma underwent laparoscopic rectal resection at one center. Of these, 303 patients received complete splenic flexure mobilization. The SFM was performed using either a medial (SFM-M; n = 41), lateral (SFM-L; n = 214), or anterior (SFM-A; n = 48) approach. There was a significantly higher rate of intraoperative complications in the SFM-L group as compared to the SFM-M or the SFM-A group (p = 0.038). Postoperative surgical complications occurred in 5 (10.6 %) patients of the SFM-A group compared to 38 patients (17.7 %) in the SFM-L group (p = 0.002) and 5 (12.1 %) patients in the SFM-M group (p = 0.037). SFM-L was also associated with a higher frequency of overall postoperative morbidity which was mainly due to wound infection rates (p = 0.001). The anterior approach for SFM in laparoscopic surgery seems to be associated with lower frequency of intra- and postoperative morbidity.

Penile prosthesis implantation for the treatment for male erectile dysfunction: clinical outcomes and lessons learnt after 955 procedures

To evaluate the clinical outcomes of penile prosthesis implantation for the treatment for erectile dysfunction (ED) over 3 decades in a centre of excellence. A total of 955 penile prostheses were implanted between June 1981 and June 2010. The mean age of the men was 53.2 (28-80) years, and the mean follow-up was 76 (12-355) months. A total of 771 men had primary implants. The most common implant was Ultrex cylinder (54 %), and the main cause of ED was organic (32 %). Primary implants showed higher rate of intra-operative complications than revision surgery (3.5 vs. 0.1 %) (p < 0.05). Prosthesis infection occurred in 0.8 % and equal incidence between diabetic and pelvic trauma patients. The average time to prosthetic revision was 102 (30-210) months. Kaplan-Meier estimates of overall penile prosthesis survival at 5 and 10 years were around 90.8 and 85.0 %. The most common mechanical failures were fluid loss (75 %). The majority of men were satisfied with the surgical outcomes, and 90 % of men would undergo penile prosthesis implant again. Penile prosthesis surgery is a safe and durable treatment option for male ED. Strict adherence to antimicrobial prophylaxis and surgical practice is paramount to ensure low complication rates and high patient satisfaction rate.

A Short Tapered Stem Reduces Intraoperative Complications in Primary Total Hip Arthroplasty

While short-stem design is not a new concept, interest has surged with increasing utilization of less invasive techniques. Short stems are easier to insert through small incisions. Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well? We compared short, flat-wedge, tapered, broach-only femoral stems to standard-length, double-tapered, ream and broach femoral stems in terms of intraoperative complications, short-term survivorship, and pain and function scores. We retrospectively reviewed the records of 606 patients who had 658 THAs using a less invasive direct lateral approach from January 2006 to March 2008. Three hundred sixty patients (389 hips) had standard-length stems and 246 (269 hips) had short stems. Age averaged 63 years, and body mass index averaged 30.7 kg/m(2). We recorded complications and pain and function scores and computed short-term survival. Minimum followup was 0.8 months (mean, 29.2 months; range, 0.8-62.2 months). We observed a higher rate of intraoperative complications with the standard-length stems (3.1%; three trochanteric avulsions, nine femoral fractures) compared with the shorter stems (0.4%; one femoral fracture) and managed all complications with application of one or more cerclage cables. There were no differences in implant survival, Harris hip score, and Lower Extremity Activity Scale score between groups. Fewer intraoperative complications occurred with the short stems, attesting to the easier insertion of these devices. While longer followup is required, our early results suggest shortened stems can be used with low complication rates and do not compromise the survival and functional outcome of cementless THA. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure—midterm results

Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse shoulder prosthesis Delta III(®) were followed up postoperatively for a mean of 46months including clinical and radiological examination. Complications were recorded and Constant score, DASH and SF36 were assessed. With the numbers given a significant reduction of pain was achieved from 8.7 to 3.0 (p < 0.001). There was a significant improvement of active flexion from 43° to 97° (p < 0.001) and active abduction from 44° to 90° (p < 0.001). However, at the same time, active external rotation with an adducted humerus decreased significantly from 26° to 12° (p = 0.012). The constant score improved significantly from 16.7 to 55.9 (p < 0.001). Sixteen patients (84%) rated their shoulder better or much better than before. In 43% an intraoperative and in 38% a postoperative complication occurred including two late stage infections which required prosthesis removal. Our results support the use of the reverse prosthesis as revision prosthesis. The reverse design helps to compensate functional deficits due to severe soft-tissue damage except active external rotation. Nevertheless, the revision is a technically demanding procedure reflected in a high rate of intraoperative complications. The rate of secondary infections of 10% remains a special concern.

Does Laparoscopic Colectomy Have a Higher Intraoperative Complication Rate Than Open Colectomy?

Division of Surgery, The Queen Elizabeth Hospital, Woodville South, South Australia, [email protected] (Hewett) University of Otago, Christchurch, New Zealand, [email protected] (Frizelle)

Does Laparoscopic Colectomy Have a Higher Intraoperative Complication Rate Than Open Colectomy?

Sammour, Tarik MBChB; Kahokehr, Arman MBChB; Connolly, Andrew B. MBChB, FRACS; Bissett, Ian P. MD, FRACS; Hill, Andrew G. MD, FRACS Author Information

Donor Complications Following Laparoscopic Compared to Hand-Assisted Living Donor Nephrectomy: An Analysis of the Literature

There are two approaches to laparoscopic donor nephrectomy: standard laparoscopic donor nephrectomy (LDN) and hand-assisted laparoscopic donor nephrectomy (HALDN). In this study we report the operative statistics and donor complications associated with LDN and HALDN from large-center peer-reviewed publications. Methods. We conducted PubMed and Ovid searches to identify LDN and HALDN outcome studies that were published after 2004. Results. There were 37 peer-reviewed studies, each with more than 150 patients. Cumulatively, over 9000 patients were included in this study. LDN donors experienced a higher rate of intraoperative complications than HALDN donors (5.2% versus. 2.0%, P < .001). Investigators did not report a significant difference in the rate of major postoperative complications between the two groups (LDN 0.5% versus HALDN 0.7%, P = .111). However, conversion to open procedures from vascular injury was reported more frequently in LDN procedures (0.8% versus 0.4%, P = .047). Conclusion. At present there is no evidence to support the use of one laparoscopic approach in preference to the other. There are trends in the data suggesting that intraoperative injuries are more common in LDN while minor postoperative complications are more common in HALDN.

Should Laparoscopic Cholecystectomy be Practiced in the Developing World?

We address the controversial issue of whether or not it is wise to perform and train laparoscopic cholecystectomy (LC) in a developing nation by reviewing the results of the first large series done in Afghanistan. Afghanistan has been devastated by 3 decades of war leaving it with deficiencies in training programs, medical technologies, and overall medical infrastructure that are among the worst in the developing world. We retrospectively reviewed 137 consecutive cholecystectomies, 102 laparoscopic and 35 open, performed by 4 senior and 3 junior surgeons trained at our hospital in Kabul from July 2005 until February 2008. Deaths, complications, conversion rate, operative time, and hospital length of stay were compared. Unrecognized major operative injuries occurred in 4 LC patients, 3 bile leaks, and 1 duodenal perforation, although there were no such injuries in the open cholecystectomy group. Complication rates were much higher for patients operated on for acute cholecystitis for both surgeon groups. Even though junior surgeons converted to open cholecystectomy more frequently than senior surgeons, they had a higher major complication rate. Hospital length of stay was 28% shorter for the laparoscopic group. The high rate of major unrecognized intraoperative complications during LC in our series underscores the difficulties inherent in performing and training LC in developing nations. Practical changes are suggested to make LC more efficient and safer in a developing world hospital.

Conversion of failed hemiarthroplasty to total hip arthroplasty: a short to mid-term follow-up study.

Background:The conversion of hemiarthroplasty (unipolar or bipolar) of the hip to total hip replacement has been reported to be associated with very high rates of intra- and postoperative complications. We present a prospective analysis of the outcome of conversion surgery in patients with failed hemiarthroplasty.Materials and Methods:Forty-four cases, 30 women and 14 men, average age 62 years (range 42-75 years) of failed hemiarthroplasty were converted to total hip replacement between January 1998 and December 2004. Groin pain was the main presenting complaint in the majority of the patients (24 out of 44). Six patients had infection and were operated with staged procedure. All acetabular and the majority (86.5%) of femoral components used in our series were uncemented.Results:After an average follow-up of 6.4 years (range, two to nine years) Harris hip scores improved from 38 (range 15-62) preoperatively to 86 (range 38 to 100) and 22 (50%) patients were community ambulators without support while 17 (38%) needed minimal support of cane. Fifteen out of 18 (83%) patients who had isolated groin pain preoperatively experienced no pain postoperatively while three patients (17%) reported only partial improvement. Intraoperative and postoperative complications included iatrogenic fracture of the femur in two, femoral perforation in two, partial trochanteric avulsion in two, fracture of the acetabular floor in three hips, and postoperative dislocation in one. None of these complications resulted in a poor long-term outcome. The rate of loosening in our series was 2.3% (one out of 44) after a mean follow-up of 6.4 years with a mean survival of 97.4% at 72 months.Conclusion:Conversion of symptomatic hemiarthroplasty to total hip arthroplasty is a safe option that gives good functional results, with marginally higher rates of intra-operative complications. The patients should be warned of the possibility of incomplete relief of groin pain postoperatively.

Total Hip Arthroplasty Using the S-ROM Modular Stem After Joint-Preserving Procedures for Osteonecrosis of the Femoral Head

The aim of this study was to test the hypothesis that a previous joint-preserving procedure for osteonecrosis of the femoral head (ONFH) would compromise the outcome of a subsequent total hip arthroplasty. The clinical and radiographic results of total hip arthroplasty using the S-ROM stem (DePuy/Johnson & Johnson, Leeds, UK) in 36 hips with failed joint-preserving procedures for ONFH were compared with those in a matched control group of 39 osteonecrotic hips without a previous joint-preserving procedure. After a mean follow-up of 4.6 years, with the exception of 1 reoperation for polyethylene wear and osteolysis, no revisions due to mechanical failure of the prostheses had been performed in the study cohort of 36 hips. However, the study group had a longer operative time, more perioperative blood loss, a higher rate of intraoperative complications, and poorer postoperative ranges of hip motion than those in the control group. These results confirm the hypothesis that a previous joint-preserving procedure for ONFH poses technical challenges for a subsequent total hip reconstruction and might have a detrimental effect on the short-term clinical outcome.

Abdominal tumours in children: 3-D visualisation and surgical planning: Günther P, Günther JP, Wunsch R. et al. Eur J Pediatr Surg 2004 (October);14:316-321

Solid abdominal tumors are of special importance in pediatric surgery. Because of the dangers of cumulative irradiation and improved delineation of soft tissues, MRI is usually employed in children for diagnostic assessment. Compiling the radiological information for surgical planning is often difficult with conventional methods. Newly developed 3-D volume rendering software is now available for visual reconstruction of tumor anatomy, utilising segmentation and other special techniques. Because of a high rate of intraoperative complications of up to 20% as described in the literature, optimal preoperative visualization is imperative. Fifteen children with solid abdominal tumors were included in this study: 7 abdominal neuroblastoma, 6 nephroblastoma, 1 ganglioneuroma, 1 ovarian teratoma. MRI examinations were performed with a 0.5 Tesla magnet using a standard protocol. All MRI data were processed with VG Studio Max 1.1, converting the two-dimensional data into three-dimensional data. The authors' experience shows that better understanding of the surgical anatomy, particularly regarding the surrounding organs and vessels, is helpful in decreasing the incidence of intraoperative injuries to these structures.

P86. Anterior lumbar interbody fusion acute complications: trapezoidal versus cylindrical devices

HYPOTHESIS: Trapezoidal and cylindrical devices involve different surgical techniques for insertion in an anterior lumbar interbody fusion. Due to these differences in technique, a higher intraoperative complication rate may be present for the cylindrical cages.

Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device.

Restoration of intestinal continuity in patients with ileostomy after total colectomy or with colostomy after Hartmann's procedure is a major operation. Herein we illustrate the validity of gasless laparoscopically assisted reversal using abdominal wall lifting. The operation was performed on 10 patients from February 1997 to May 1999. Seven of them had a left iliac stoma after a Hartmann resection, and three had an ileostomy after total colectomy. The laparoscopic reversal was completed in eight patients; the two others were converted to an open procedure. Three major complications occurred (30%). There were no deaths. The average operation time was 192 min (range, 125-265). Time of discharge from surgery averaged 9.5 days. Mean follow-up of these patients was 12 months and negative. Laparoscopically assisted ileo- or colorectal anastomosis without pneumoperitoneum and using a laparotenser can be considered for the reversal of patients with ileostomy or colostomy. Even taking the high rate of intraoperative or postoperative complications into consideration, the advantages that make such a laparoscopic approach suitable include reduced trauma related to a second major abdominal operation, reduced postoperative pain, and fewer cutaneous tissues exposed to bacterial contamination. Moreover, the use of a laparotenser makes it possible to operate on elderly patients with cardiovascular diseases. In the absence of pneumoperitoneum, it becomes possible to use traditional instruments, with a consequent reduction in costs.