Laparoscopic Total Abdominal Colectomy Research Articles

Laparoscopic Total Colectomy: A New Surgical Alternative for Colon Inertia

Objective: Abdominal total colectomy is recognized as a therapeutic option for patients with intractable constipation due to colonic inertia. However, postoperative complications such as intestinal obstruction, wound infection, long scars of the abdominal wound may bother the patients. Recently, laparoscopic colectomy for colon lesions has become an increasingly accepted procedure. It has been reported to have many advantages because of its minimal invasiveness. The aims of this study were to compare difference between laparoscopic colectomy and open colectomy in the treatment of colon inertia, to assess the safety of this laparoscopic approach and to determine whether the proposed advantages hold true.Methods: Eighty colon inertia patients were collected from January 2005 to January 2009. They were divided into 2 groups. Group I consisted of 38 patients who underwent laparoscopic total abdominal colectomy with ileorectal anastomosis. Group II consisted of 42 patients who underwent open total abdominal colectomy with ileorectal anastomosis. The data collected from participants in the study included age, gender, intraoperative estimated blood loss, median operative time, time at which a clear liquid diet was started, postoperative morbidities, mean length of hospital stay, postoperative narcotic usage, and incision length in both groups. The two groups were compared on the basis of these data.Results: The perioperative and postoperative outcomes including intraoperative estimated blood loss, (group I: 87.1±27.4 ml vs group II: 127.9±30.8 ml) length of surgical incision (group I: 4.5±0.2 cm vs group II: 23.7±1.4 cm), mean length of hospital stay (group I: 6.3±1.3 days vs group II: 8.4±1.6 days), and narcotic usage for postoperative wound pain (group I: 1.7±0.5 days vs group II: 2.8±0.5 days) in group I were significantly superior to those in group II. The incidence of complications was also significantly lower in group I than that in group II. Conclusions: From our results, it can be said that laparoscopic total colectomy was the better surgical alternative for colon inertia.

Single incision laparoscopic total abdominal colectomy with ileorectal anastomosis for synchronous colon cancer

Single incision laparoscopy is currently performed mostly for basic laparoscopic procedures involving single abdominal quadrants. The aim of this case report is to show that single incision laparoscopic techniques can be utilized for complex abdominal laparoscopic procedures with a large target organ and a working space involving all quadrants of the abdominal cavity. A single incision laparoscopic total abdominal colectomy with an ileorectal anastomosis and intraoperative CO(2) colonoscopy was performed for a patient with synchronous adenocarcinoma of the cecum and the sigmoid colon. The patient was discharged home on postoperative day 4 and had no immediate postoperative complications. Single incision laparoscopy is feasible for complex colorectal procedures. Some of the techniques used may be adapted further to achieve colonic resection via a natural orifice in the future.

Fulminant Ulcerative Colitis

A 20-year-old man with a recent diagnosis of ulcerative colitis had increasingly frequent bloody diarrhea and weight loss. He was admitted to our hospital after showing no response to treatment with intravenous corticosteroids, total parenteral nutrition, and a transfusion of packed red cells at another institution. A computed tomographic scan of the abdomen (Panel A) showed a severely dilated transverse colon (arrow) and free air (arrowhead). The patient underwent an emergency laparoscopic total abdominal colectomy with end ileostomy. The surgical specimen showed parallel lines of ulceration surrounded by inflamed mucosa (Panel B). Microscopically, the presence of crypt abscesses, lymphoplasmacytic infiltrates, . . .

Hand‐assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy

We evaluated outcomes after hand-assisted (HALC) and straight laparoscopic (LC) techniques for the initial laparoscopic total abdominal colectomy (TAC) procedures performed by surgeons starting their laparoscopic careers. The first eight HALC cases of two surgeons performing TAC by this technique (Group A) were compared with the first (Group B) and last eight (Group C) TAC cases of three surgeons performing LC. Groups A and B were compared with a matched group of open total colectomy cases (Group D) and to the eight cases performed by an experienced surgeon (Group E). Demographics, intra-operative and postoperative outcomes including operation time, morbidity, conversion and readmission rates and length of hospital stay (LOS) were compared using Wilcoxon or Chi-squared tests. Demographics of the patients were similar. Groups A, B C and E had similar operating time (P = 0.10) which was significantly longer than Group D (P < 0.0001). Morbidity (P = 0.75) and readmission rates were similar (P = 0.89). Conversion rate was significantly higher for Group B (Group B: 41.7%vs Group A: 0%, P = 0.008), in the early period. LOS was comparable between minimally invasive groups but significantly shorter than open surgery group (P = 0.0005). For Groups A and C, operating time (P = 0.55), conversion rate (P = 0.11), morbidity (P = 0.83) and LOS (P = 0.12) were similar. Hand-assisted laparoscopic colectomy may be associated with a significantly shorter learning curve for TAC as results are better than early LC and comparable with LC performed by experienced laparoscopic surgeons. It may be a better option for surgeons early in their laparoscopic career.

Laparoscopic vs. Open Total Abdominal Colectomy for Severe Colitis

This study was designed to compare short-term outcomes of laparoscopic vs. open total abdominal colectomy and end ileostomy for severe ulcerative colitis and to evaluate the impact of the initial surgical approach on subsequent operations for three-stage restorative proctocolectomy. Perioperative demographic and outcome data for patients with severe ulcerative colitis who underwent laparoscopic (n = 37) or open (n = 41) total abdominal colectomy at the initial stage of a three-stage restorative proctocolectomy were compared. Each stage was analyzed independently by using two-tailed t-tests and analysis of covariance. Patients who underwent laparoscopic total abdominal colectomy had higher serum albumin (P = 0.0003), less inpatient narcotic usage (P = 0.0143), faster return of bowel function (P = 0.0001), and shorter length of stay (P = 0.039). There were no differences in perioperative parameters for the restorative proctectomy and ileostomy closure. The laparoscopic total abdominal colectomy patients underwent subsequent restorative proctectomy 49 days sooner (P = 0.0044) and ileostomy closure 17 days sooner (P = 0.00003) than the open total abdominal colectomy patients. Laparoscopic abdominal colectomy for severe ulcerative colitis in selected patients is safe and is associated with short-term benefits that may lead to faster recovery and progression to completion of restorative proctocolectomy.

Laparoscopic Total Colectomy: An Evolutionary Experience

Laparoscopic total abdominal colectomy and total proctocolectomy are technically challenging operations. Advances in minimally invasive techniques, including sleeveless hand-assist devices, may influence performance of these procedures. This study was designed to evaluate the results of laparoscopic total colectomy and to compare the hand-assisted approach with straight laparoscopy. Sequential patients undergoing hand-assisted and straight laparoscopic total abdominal colectomy and total proctocolectomy from 1997 to 2004 were identified from a single institution prospective database involving four colorectal surgeons, of which three had limited laparoscopic experience. Patient characteristics, perioperative parameters, and outcomes were assessed. A total of 130 patients were analyzed. Sixty-nine patients underwent total abdominal colectomy (hand-assisted 17 vs. straight laparoscopic 52), and 61 underwent total proctocolectomy (hand-assisted 28 vs. straight laparoscopic 33). For both total abdominal colectomy and total proctocolectomy, the hand-assisted and straight laparoscopic groups were well matched. Although no differences were observed in operative blood loss and intraoperative complications, hand assistance resulted in fewer overall conversions to open (1/45 (2.2 percent) vs. 6/85 (7.1 percent); P < 0.01), with no conversions in the total abdominal colectomy group (0 vs. 9.6 percent; P = 0.05). There was a trend toward reduced operative time with hand assistance, and nonlaparoscopic staff surgeons performed a greater proportion of the hand-assisted cases (22.2 vs. 10.6 percent; P < 0.05). Laparoscopic total colectomy is technically feasible and safe. With a significant reduction in conversions and a greater proportion of cases performed by nonlaparoscopic surgeons, there was an evolutionary shift to a hand-assisted technique. A hand-assisted approach may be a useful alternative to a straight laparoscopic approach for this technically challenging operation.

Laparoscopic Total Abdominal Colectomy in the Acute Setting

We report results from a single surgeon's 10-year team experience with laparoscopic total abdominal colectomy. We review our series, which includes a large subgroup of ill, high-risk patients with acute colitis requiring urgent surgery. From 1993 to 2003, we performed 65 laparoscopic total abdominal colectomies. All patients referred for total abdominal colectomy were offered the laparoscopic approach. We prospectively collected the following data on all patients: demographics, surgical indications, preoperative status, duration of surgery, intraoperative blood loss, operative complications, length of stay, subsequent operations, patient satisfaction, and lessons learned from our team experience. Preoperative diagnoses included ulcerative colitis (n=55), Crohn's colitis (n=3), colonic inertia (n=4), and familial adenomatous polyposis (n=3). Among the patients with inflammatory bowel disease, 70% of cases were performed on ill patients, refractory to medical management, requiring urgent surgery. This subgroup was managed with laparoscopic total abdominal colectomy and Brooke ileostomy, with ileoanal pouch anastomosis deferred. Operative times were long, ranging from 6 to 11 hours. Mean intraoperative blood loss was 200 ml. Mean length of stay was 4.3 days and ranged from 2 to 13 days. There were no conversions to open surgery and there were no deaths. Complications occurred in 12% of patients and included intra-abdominal abscess (n=2), wound infection (n=3), stoma stenosis (n=1), and incisional hernia (n=2). Postoperative patient satisfaction was high. Subsequent operations, including restorative proctectomy, were also performed laparoscopically. Laparoscopic total abdominal colectomy is technically challenging and requires a team approach but offers patients significant benefit in length of stay and surgical recovery. This operation can be effectively used with minimal morbidity in difficult, ill patients requiring urgent surgery.

A case-controlled study of laparoscopic total abdominal colectomy and lleorectal anastomosis (TAC-IRA) with open TAC-IRA for slow transit constipation (STC)

A case-controlled study of laparoscopic total abdominal colectomy and lleorectal anastomosis (TAC-IRA) with open TAC-IRA for slow transit constipation (STC)

A case-controlled study of laparoscopic total abdominal colectomy and lleorectal anastomosis (TAC-IRA) with open TAC-IRA for slow transit constipation (STC)

A case-controlled study of laparoscopic total abdominal colectomy and lleorectal anastomosis (TAC-IRA) with open TAC-IRA for slow transit constipation (STC)

Laparoscopic-assisted surgery for constipation

The aim of this study was to evaluate the safety, outcome and disability of various forms of laparoscopic-assisted colectomy for constipation. Between August 1991 and February 1995, 14 patients with constipation who underwent laparoscopic assisted total abdominal colectomy with ileorectal anastomosis (TAC + IR) or sigmoidectomy with colorectal anastomosis (SC + CR) with or without rectopexy were analyzed. Parameters included age, sex, preoperative medical treatment and evaluation, constipation score, indication for surgery, procedure performed, length of surgery, postoperative ileus, and hospitalization as well as morbidity, cosmesis, functional outcome and return to partial and full activity. Surgery was undertaken for colonic inertia (6 patients) and obstructing sigmoidocele with or without prolapse (8 patients) in 12 females and 2 males with a mean age of 47.5 (range 22–77) years. The mean history of laxative- or enema-dependent constipation was 18.3 (range 7–35) years and the mean constipation score was 24.4 (range 20–29). The overall mean operating time was 217.5 (range 125–325) min; 260 (range 195–315) min in the patients with TAC + IR, and 185.6 (range 125–325) min in the patients with SC + CR with or without rectopexy (P < 0.05). The mean length of postoperative ileus was 3.8 (range 2–7) days, and the length of hospitalization was 7.6 (range 4–15) days. There were 3 (21%) cases of intraoperative complications, and 4 cases of (29%) postoperative complications. At a mean follow-up of 37.8 (range 18–60) months, the mean frequency of bowel movements had increased from 2.5 per week preoperatively to 8.4 per week postoperatively (P < 0.0001). Ten patients reported excellent or good results relative to cosmesis. The mean time to return to partial activity was 1.7 (range 1–3) weeks, and return to full activity was 5.1 (range 3–10) weeks. Although laparoscopic procedures for constipation have definite advantages including better cosmesis and more rapid return to partial and full acitivity, disadvantages include the long operating time that may preclude its routine application.

Laparoscopic Oncologic Total Abdominal Colectomy with Intraperitoneal Stapled Anastomosis in a Canine Model

The purpose of this study was to evaluate the feasibility of performing an oncologic type of colectomy using laparoscopic techniques with intraperitoneal stapled ileorectal anastomosis in a canine model. In 21 dogs, laparoscopic oncologic colectomy was carried out using dissection with a contact Nd:YAG laser. The right, middle colic, and inferior mesenteric arteries were transected close to their origins, and all adjacent mesenteric lymph nodes were removed. Ileorectal anastomosis was performed using a circular end-to-end stapler especially designed for laparoscopic surgery. Two weeks after surgery, all animals were killed. The number of remaining mesenteric lymph nodes, bursting pressure of ileorectal anastomosis, and postoperative morbidity were evaluated. No major intraoperative complications were recorded. One dog died postoperatively from an anastomotic leak. All dogs passed feces in the first 24 postoperative hours. Median operative time was 145 min (90-240 min). The number of remaining colonic mesenteric lymph nodes was 0, and median anastomotic bursting pressure was 325 mm Hg (183-415 mm Hg). The median distance from ileocolic anastomosis to anal verge was 8.5 cm (6.0-11.0 cm). Laparoscopic oncologic colectomy with wide mesenteric clearance of lymph nodes and intraperitoneal stapled ileorectal anastomosis is feasible and safe in a canine model.