Left Colon Resection Research Articles

Mechanical bowel preparation and antimicrobial prophylaxis in elective colorectal surgery in Switzerland—a survey

The aim of this study was to assess the use of mechanical bowel preparation (MBP) and antimicrobial prophylaxis in elective colorectal surgery in Switzerland. Ninety-eight heads of surgical departments in Switzerland and 42 visceral surgeons in private practice were asked to answer an 18-item questionnaire in October 2008 about arguments in favor of or against MBP. The participants also indicated whether they use MBP and antimicrobial prophylaxis in colorectal surgery, and if so, what agents were used. Of the participants, 117/140 (83%) responded. Additional data were collected pertaining to the respondents' experience and work situation. MBP was used significantly more often for rectal surgery than for left colonic resections (83% vs. 53%; p < 0.001) and more often for left than for right colonic resections (53% vs. 43%; p = 0.001), regardless of the open or laparoscopic approach. Younger surgeons and surgeons with a higher case load in colorectal surgery used MBP significantly less frequently in open right colonic resections. For MBP, cathartics were used in 90% of patients, and enemas were used in 10% of patients. Of the respondents, 37% considered MBP to be useful, even very useful. Based on the literature, because of introduction of fast-track protocols or for considerations of patient comfort, 86% of the respondents had changed the bowel preparation regime during the last 10 years in terms of a reduction of the quantity of cathartics or restricted the indications for MBP. Antimicrobial prophylaxis was used by 100% of the respondents, 88% used a single prophylactic dose only, while 70% administered the antibiotics 30-59 min before the incision. Most of the surgeons used second-generation cephalosporins in combination with metronidazole, and 24% changed the antibiotic agent or reduced the duration of administration of antibiotics during the last 10 years. MBP is often used in open and laparoscopic rectal surgery, but not in right colonic resections. Scientific evidence regarding MBP has yielded a rethinking about rigorous bowel preparation regimes. As of now, surgeons in Switzerland are not yet unanimously ready to abandon MBP in elective colorectal surgery. In Switzerland, surgeons are influenced by the benefit of antimicrobial prophylaxis in colorectal surgery.

Natural Orifice Specimen Extraction for Avoiding Laparotomy in Laparoscopic Left Colon Resections: A New Approach Using the McCartney Tube and the Tilt Top Anvil Technique

Classical laparoscopic left colon resection requires a minilaparotomy. This wound can cause pain and morbidity. We describe our technique to avoid minilaparotomy by natural orifice specimen extraction. A four-port standard laparoscopic dissection for diverticular disease and small tumors of the left colon was performed. A silicon McCartney tube was transanally inserted into the rectum to remove the specimen and to pass the anvil of the circular stapler into the abdominal cavity. The head of the anvil was mechanically pretilted to facilitate introduction into the proximal colon. Double-stapled anastomosis was performed in the usual manner. Eight patients with diverticular disease or small tumors were operated. There were no adverse events. Operating time ranged between 95 and 180 minutes. For malignancies, tissue margins and lymphadenectomy were oncologically adequate. Four week follow-up was uneventful. The described natural orifice specimen extraction technique has the potential to avoid incision-related morbidity of the minilaparotomy in laparoscopic left colon resections.

Elective Surgery for Diverticulitis is Associated with High Risk of Intestinal Diversion and Hospital Readmission in Older Adults

PurposeThis study seeks to compare outcomes (in-hospital mortality, colostomy rates, and 30-day readmission rates) in older adult patients undergoing emergency/urgent versus elective surgery for diverticulitis. MethodsData were derived from the 100% Medicare Provider Analysis and Review (MEDPAR) inpatient file from 2004–2007. All patients 65 years of age and above with a primary diagnosis of diverticulitis that underwent left colon resection, colostomy, or ileostomy were included. The primary outcome variable was in-hospital mortality. Secondary outcome variables included intestinal diversion, 30-day post-discharge readmission rates, discharge destination, length of stay, and total charges. Patients were grouped in two categories for comparison: emergent/urgent (EU) versus elective surgery, as defined by admission type. Multivariate analysis was performed adjusting for age (categorized by five groups), gender, race, and medical comorbidity as measured by Charlson Index. ResultsFifty-three thousand three hundred sixteen individuals were eligible for inclusion, with 23,764 (44.6%) in the elective group. On average, EU patients were older (76.8 vs. 73.9 years of age, p < 0.001) and less likely to be female (65.4% vs. 71.1%, p < 0.001). EU patients had higher in-hospital mortality (8.0% vs. 1.4%, p < 0.001), higher intestinal diversion rates (64.2% vs. 12.7%, p < 0.001), and higher 30-day readmission rates (21.4% vs. 11.9%, p < 0.001) and the worse outcomes persisted even after adjustment for risk factors. Unadjusted and adjusted mortality rates dramatically increased by age, although the affect of age on mortality was more pronounced in the elective group where mortality rates ranged from 0.56% in patients 65–69 years old to 6.5% in patients 85+ years old. The rates of ostomy and 30-day readmission generally increased with age, with worse outcomes noted particularly in the elective group. ConclusionsAs expected, older adults undergoing emergent/urgent surgical treatment for diverticulitis have significantly increased risks of poor outcomes compared with elective patients. While advancing age is associated with a substantial increase in mortality, intestinal diversion and 30-day readmission after surgery for diverticulitis, this affect is especially evident among patients undergoing elective colectomy. Our data suggest that given the considerable risk of prophylactic colon resection in elderly patients with sigmoid diverticulitis, a reappraisal of the proper role of elective colectomy in this population may be warranted.

Trends in Surgery for Crohn's Disease in the Era of Infliximab

To examine the use of surgical procedures for Crohn's disease since the introduction of infliximab. Prior studies have shown that the overall rate of surgery for Crohn's disease has not changed significantly since the introduction of infliximab, an immunomodulator considered particularly effective in treating Crohn's fistulas. How infliximab has affected individual rates of specific types of procedures, particularly surgery for intestinal fistulas, is unknown. We used the Nationwide Inpatient Sample to identify all hospital admissions for Crohn's disease for each year from 1993 through 2004. Cases of Crohn's disease and relevant surgical interventions were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Using US Census data to establish population denominators, trends in population-based rates of use of these procedures were examined over time. Trends were tested for significance with Spearman rank correlation tests. From 1993 to 2004, there was no statistically significant change in population-based rates of small bowel and right colon resection, while rates of left colon resection, other colon resection, and rectal resection declined moderately. However, rates of surgical repair of fistulas of the small intestine, the most commonly performed fistula operation, increased by 60%, from 1.5 per 1,000,000 in 1993 to 2.4 per 1,000,000 in 2004 (P = 0.04). During the period of adoption of infliximab as a novel treatment for Crohn's disease, overall rates of bowel resections have either remained relatively stable or decreased moderately, while rates of small bowel fistula repair have increased significantly. These findings call into question the effectiveness of infliximab in preventing the need for surgery for Crohn's disease at the population level.

Butyrate Enemas Improve Intestinal Anastomotic Strength in a Rat Model

Anastomotic leakage is a common clinical complication with incidences up to 10% to 17% in colorectal surgery, leading to high morbidity and mortality. Butyrate is the product of colonic fermentation of indigestible carbohydrates and is considered beneficial to gastrointestinal healing. The aim of this study was to investigate the effect of intraluminal supplementation of butyrate on colonic anastomotic strength in a rat model. Wistar rats were randomly assigned to one of 3 groups (18 animals each). All rats underwent a 1-cm left colonic resection and end-to-end anastomosis with 4 interrupted sutures. Group I underwent no other treatment and served as the control, group II received daily 5 mL of 60 mM sodium butyrate enemas postoperatively, and group III received placebo enemas. On the third or seventh postoperative day, rats (n = 9 per time point) were anesthetized and anastomotic bursting strength was assessed. As a consequence of anastomotic leakage, 3 rats (16.6%) in group I, 1 rat (5.6%) in group II, and 2 rats (11.2%) in group III died. Mean anastomotic bursting pressures at day 3 were not significantly different between groups (53, 64, and 68 mm Hg for group I, II, and III, respectively, P = .777). At day 7, bursting pressures were 118, 225, and 129 mm Hg for groups I, II, and III, respectively (P = .0006). Group II showed an increased mature-to-immature collagen ratio (P = .035). Postoperative intestinal butyrate supplementation enhances anastomotic bursting strength in a left-sided partial colonic resection rat model, which can be explained by increased collagen synthesis and maturation.

Randomized clinical trial of laparoscopic versus open left colonic resection

The main aim of this study was to compare short-term results and long-term outcomes of patients undergoing laparoscopic versus open left colonic resection. Between February 2000 and December 2004, all adult patients undergoing elective left colonic resection were assessed for eligibility to the study. The protocol for postoperative care was the same in both groups. Cost-benefit analysis was based on hospital costs. Quality of life, long-term morbidity and 5-year survival were also evaluated. Some 268 patients undergoing left colonic resection were assigned randomly to the laparoscopic (n = 134) or open (n = 134) approach. The short-term morbidity rate was 20.1 per cent in the open group and 11.9 per cent in the laparoscopic group (P = 0.094). Hospital stay was longer in the open group (8.7 versus 7.0 days for the laparoscopic approach; P = 0.002). Cost-benefit analysis showed an additional cost of euro66 per patient randomly allocated to the laparoscopic group. Quality of life was significantly improved in the laparoscopic group 6 months after surgery, but no difference was found subsequently. The long-term morbidity rate was 11.9 per cent in the open group and 7.5 per cent in the laparoscopic group (P = 0.413). The 5-year survival rate of patients with cancer was 66 and 72 per cent for open and laparoscopic groups respectively (P = 0.321). Laparoscopic left colonic resection resulted in an earlier recovery after surgery. As cost-benefit analysis and long-term follow-up showed similar results, the laparoscopic approach should be preferred to open surgery.

Extended left colon resections as part of complete cytoreduction for ovarian cancer.

e15555 Background: Colectomy is a common part of cytoreductive surgery. The most common segment of the colon resected is the rectosigmoid. Extended left-sided colectomies are rarely performed. With increased emphasis on the importance of maximal cytoreductive surgery it is becoming more important to understand the outcomes related to such a procedure. The purpose of this report is to evaluate the quality of life issues related to extended left colectomies. Methods: Data on all patients who underwent cytoreductive surgery between April 2007 and April 2009 was prospectively recorded. 19 patients underwent extended left colon resections. The data from these cases was evaluated with particular attention directed at quality of life issues surrounding postoperative bowel function, and tolerance of postoperative chemotherapy. Results: 9 underwent resection of the left hemicolon plus the hepatic flexure. 6 underwent resection of the left hemicolon, hepatic flexure, and the ascending colon. 4 underwent subtotal colectomies. Temporary diverting loop ileostomies were performed on 18 of the 19 patients each of whom consented for intraperitoneal chemotherapy. No delays in chemotherapy were observed. Median number of bowel movements at 6, 9 and 12 months were 2, 2 and 1, respectively. No fecal incontinence was observed. Patients expressed satisfaction with their bowel surgery and denied any significant decrease in their quality of life due to their bowel function. A single chemotherapy cycle was delayed in 1 patient due to dehydration and electrolyte abnormalities. Each subsequent cycle was given on time with additional days of outpatient hydration. Conclusions: Extended left colon resection is a reasonable technique to include in patients requiring maximal cytoreduction. Quality of life related to bowel function is acceptable and patients express satisfaction with the degree of surgery. With attention to the additional hydration requirements needed after extended left colon resections, chemotherapy can be given on schedule and without delays No significant financial relationships to disclose.

Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease

Laparoscopic sigmoidectomy has become the standard procedure in elective surgery for recurrent diverticular disease. To realize further benefits of this minimal invasive procedure and to offer less postoperative pain, shorter recovery time, reduced complications, and improved cosmetic results, attempts are being made to minimize the number of necessary skin incisions for trocar positioning. One method is to use only one port for laparoscopic access to perform diverticular-related elective sigmoidectomies. Between 7 July and 4 August 2009, 10 consecutive patients were referred for partial left colon resection due to multiple episodes of diverticulitis. In all cases, access to the abdomen was achieved through a 2- to 2.5-cm single incision via the umbilicus followed by insertion of the single-incision laparoscopic surgery (SILS™) port system. Outcomes such as change in the procedural method, operative time, postoperative complications, and length of stay were recorded. Of the 10 consecutive sigmoidectomies, 9 were performed successfully with the SILS™ procedure using only one incision in the umbilicus. No mortalities or major complications were noted. The median operating time was 120 min, and the median postoperative hospital stay was 7 days. As an alternative to the standard laparoscopic procedure, single-incision laparoscopic sigmoidectomy via the umbilicus is technically feasible and effective. This attractive procedure aims to increase the patient's comfort further after abdominal surgery.

Mobilization of the Splenic Flexure: A Standard in Laparoscopic Left Colon and Rectum Resections!

Mobilization of the Splenic Flexure: A Standard in Laparoscopic Left Colon and Rectum Resections!

Critical Assessment of Risk Factors for Complications After Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy for Pseudomyxoma Peritonei

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has demonstrated improved survival in selected patients with pseudomyxoma peritonei (PMP). However, this aggressive treatment modality has been consistently associated with variable rates of perioperative mortality between 0% and 18% and morbidity between 30% and 70%. This study evaluates the clinical and treatment-related risk factors for perioperative morbidity and mortality in PMP patients who underwent CRS and PIC. A total of 145 consecutive CRS and PIC procedures for PMP performed between January 1996 and March 2009 were evaluated. The association of 12 clinical and 20 treatment-related risk factors with grades III and IV/V morbidity were assessed by univariable and multivariable analysis. The mortality (grade V) rate was 3%. The morbidity rates of grades III and IV were 23% and 22%, respectively. Eight factors were associated with grade IV/V morbidity on univariable analysis: peritoneal cancer index >or=21 (P = .034), ASA score >or=3 (P = .003), operation duration >or=10 h (P < .001), left upper quadrant peritonectomy procedure (P = .037), colonic resection (P = .012), ostomy (P = .005), ileostomy (P = .012), and transfusion >or=6 units (p = 0.011). Multivariable analysis showed 2 significant risk factors for grade IV/V morbidity: ASA >or= 3 (P = .006) and an operation length >or=10 h (P < .001). CRS and PIC has an acceptable rate of perioperative mortality and morbidity in selected patients with PMP. Patients with bulky disease who undergo a long operation are at a particularly high risk of a severe adverse event.

Robotics: Left Colon and Sigmoid Resection

There are many potential advantages of using robotics for resection of the left colon and the sigmoid colon. These include stable traction of the vascular pedicles, preservation of the aortic and the hypogastric nerve plexus, improved accessibility for take-down of the splenic flexure, and easily applicable intracorporeal colorectal or colocolic anastomosis. This chapter provides a detailed description of the technique used in a robotic dissection for a left colectomy or sigmoidectomy.

Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing

This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration. One hundred twenty wistar albino rats were randomized to one of four groups (I-IV, 30 rats in each) and underwent a standardized left colon resection and anastomoses. The anastomoses of the rats in groups II (AM) and IV (5-FU + AM) were covered with AM. Saline solution (2 ml/day; groups I (control) and II) or 5-FU (20 mg/kg/day; groups III (5-FU) and IV) was administered to the rats intraperitoneally once daily from the day of operation until sacrificed. Half of each group was sacrificed on the postoperative day 4 (IA, IIA, IIIA, and IVA) and other half on the postoperative day 8 (IB, IIB, IIIB, and IVB), and their anastomoses were evaluated when sacrificed. The dehiscence rate of anastomotic dehiscence and adhesion formation were significantly higher in groups IIIA and IIIB compared with groups IVA and IVB, respectively. Bursting pressure was significantly higher in the 5-FU + AM groups than in the 5-FU groups. The inflammatory cell infiltration was significantly lower in groups IIIA and IVA compared with group IA, in groups IIIB and IVB compared with group IB, and in group IVA compared with group IIIA. Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline levels were significantly higher in the 5FU + AM groups compared with control and 5-FU groups. Malondialdehyde levels were significantly higher in the 5-FU groups than in the 5-FU + AM groups. Covering colon anastomoses with AM protects them, preventing leakage and reversing the negative effects of 5-FU administration.

Diverticulitis in California from 1995 to 2006: Increased Rates of Treatment for Younger Patients

Colonic diverticular disease is responsible for over 300,000 admissions and expenditures exceeding $2.7 billion/year. There is recent evidence that rates of treatment for diverticulitis have increased in the United States over the last decade. We hypothesize that these national trends of increasing rates of hospitalizations for diverticulitis would be found in an analysis of a single-state discharge database. Data from the Office of Statewide Health Planning and Development were used to analyze treatment for diverticulitis in California from 1995 to 2006. For each hospitalization, surgical care was determined based on procedure codes for left colon resection and/or colostomy. Overall numbers of admissions for acute diverticulitis increased throughout the 12-year study period with an estimated annual percentage of change (EAPC) of 2.1 per cent (P < 0.001). Rates of admissions increased most rapidly in patients 20 to 34-years-old (EAPC = 8.6%, P < 0.001) and 35 to 49 years old (EAPC = 5.7%, P < 0.001). Elective colectomies had an EAPC of 2.1 per cent (P < 0.001), which was also most dramatic in younger age groups. Between 1995 and 2006 we found significant increases in both the rates of hospitalization for diverticulitis and rates of elective surgical treatment in California. These increases are entirely due to higher rates of care for younger patients.

Loop ileostomy versus loop transverse colostomy for temporary fecal diversion after colorectal anastomosis

Background: Leakage from low colorectal anastomosis could be reduced by using covering stoma to divert fecal stream. Controversy is still present as to whether loop ileostomy (LI) or loop transverse colostomy (LTC) is the optimal method of defunctioning such anastomosis. Methods: Patients requiring defunctioning following anterior resection or emergency left colonic resection were randomized to receive either LI or LTC. Comparison was made between both groups regarding efficacy & complications. The minimum follow up after stoma closure was 3 months (mean 10 months). Results: Between January 2007 and April 2009, 62 patients were randomized into 2 groups (LI 32, LTC 30). There were no significant differences in the mortality, postoperative leakage, stoma prolapse, parastomal hernia, parastomal fistula, incisional hernia, postoperative bowel obstruction, or skin irritation. However, there were significant difference in favour of LI including less evidence of wound infection, less hospital stay, less stomal retraction or necrosis, less time for creation of stoma, less time of bowel transiet and better patient adaptation, while dehydration and time of closure was in favour of LTC. Conclusion: In this randomized study, both methods appear to provide satisfactory protection method for the low colorectal anastomosis, but LI in general was associated with little complications specially wound infection & stoma related complications, which favours it as a covering stoma.

Extended left colon resections as part of complete cytoreduction for ovarian cancer: Tips and considerations

Objectives Colectomy is a common part of cytoreductive surgery. The most common segment of the colon resected is the rectosigmoid. Extended left-sided colectomies are rarely performed. With increased emphasis on the importance of maximal cytoreductive surgery it is becoming more important to understand the outcomes related to such a procedure. The purpose of this report is to evaluate the quality of life issues related to extended left colectomies. Methods Data on all patients who underwent cytoreductive surgery between April 2007 and April 2009 was prospectively recorded. Nineteen patients underwent extended left colon resections. The data from these cases was evaluated with particular attention directed at the quality of life issues surrounding postoperative bowel function, and tolerance of postoperative chemotherapy. Results Nine underwent resection of the left hemicolon plus the hepatic flexure. Six underwent resection of the left hemicolon, hepatic flexure, and the ascending colon. Four underwent subtotal colectomies. Temporary diverting loop ileostomies were performed on 18 of the 19 patients each of whom consented for intraperitoneal chemotherapy. No delays in chemotherapy were observed. Median number of bowel movements at 6, 9 and 12 months were 2, 2 and 1, respectively. No fecal incontinence was observed. Patients expressed satisfaction with their bowel surgery and denied any significant decrease in their quality of life due to their bowel function. Conclusion Extended left colon resection is a reasonable technique to include in patients requiring maximal cytoreduction. Quality of life related to bowel function is acceptable and chemotherapy is not delayed.

Support for the Selective Approach to Splenic Flexure Mobilisation

I have read with interest the argument for and against routine mobilisation of the splenic flexure in anterior resection for cancer. In our practice, the decision to mobilise the splenic flexure for left colonic or anterior resections is made easy; most of our patients (females more than males) have redundant left and sigmoid colons and the incidence of diverticular disease is rare. After division of the inferior mesenteric artery just distal to the left colic artery, the colon can be brought down to the pelvis without tension or compromised vascularity. Only on some rare occasions was the mobilisation deemed necessary to avoid tension at the anastomotic site. What was used to be practiced in open surgery is now translated even more precisely and efficiently during laparoscopic colonic resection. Based on this, I totally support (at least in our population) the selective approach to splenic flexure mobilisation which was advocated and argued for by Kennedy and Jenkins.

Does age influence results of laparoscopic surgery for colorectal cancer in elderly patients?

Materials and methods Consecutive 87 patients who had laparoscopic resection of right colon, left colon, sigma and/or supraperitoneal rectum for colorectal carcinoma or adenoma with medium/severe dysplasia from June 2005 to August 2008 were included. Two age-matched cohorts of patients were compared: 45 patients (group 1) of 65 years or older and 42 patients younger than 65. All of the patients underwent preoperative exams, colonoscopy with multiple biopsy and CT-scan, and all data concerning demographics, disease, details of operations and postoperative events were collected prospectively.

Prevalence of Internal Hernias After Laparoscopic Colonic Surgery

IntroductionLaparoscopic approach for colorectal resections is gaining popularity. Internal small bowel herniation (SBH) through a mesenteric defect has been described and, although rare, is a severe complication. The aim of this study was to evaluate the incidence and outcome of internal hernias after laparoscopic colorectal resection. Material and methodsDuring a 5-year period, all patients who underwent laparoscopic left colon resection were included in the study. A retrospective data base query was performed searching for all patients in whom SBH required surgical reintervention. ResultsA total of 436 laparoscopic left colorectal resections were performed from January 2000 to July 2006. Five male patients presented symptomatic internal hernias and required re-operation. Four had a resection for cancer and one for sigmoiditis. The mesenteric defect was not initially closed in three cases. In all cases, we found small bowel hernias through the mesocolon defect. One patient was re-operated on post-op day 2 for mesenteric ischemia and died after 24 h. DiscussionInternal hernia is a rare but fatal complication after laparoscopic colonic resection. Suspicion of this diagnosis requires emergency re-operation because symptoms are nonspecific. ConclusionAll mesenteric defects created during colorectal laparoscopy surgery should be meticulously closed.

Full Robotic Left Colon and Rectal Cancer Resection: Technique and Early Outcome

The technique for robotic resection of the left colon and anterior resection of the rectum with total mesorectal excision is not well defined. In this study we describe a method that standardizes robot and trocar position, and allows for a complete mobilization of the left colon and the rectum, without repositioning of the surgical cart. Outcome and pathology findings are also reported. From January 2007 to May 2008 a total of 55 consecutive patients affected by rectal and left colon cancer were operated on, with full robotic technique, using the Da Vinci robot. Data regarding outcome and pathology reports were prospectively collected in a dedicated database. The following procedures were performed 27 left colectomies, 17 anterior resections, 4 intersphincteric resections, 7 abdominoperineal resections. There were 21 female and 34 male patients with a mean age of 63 +/- 9.9 years. Mean operative time was 290 +/- 69 minutes, ranging from 164 to 487 min., none were converted to open surgery. The median number of lymph nodes harvested was 18.5 +/- 8.3 (range 5-45), and circumferential margin was negative in all cases. Distal margin was 25.15 +/- 12.9 mm (range 6-55) for patients with rectal cancer, and 31.6 +/- 20 mm for all the patients in this series. Anastomotic leak rate was 12.7% (7/55); in all cases conservative treatment was successful. Full robotic colorectal surgery is a safe and effective technique that exploits the advantages of the Da Vinci robot during the whole intervention, without the need to make use of hybrid operations. Outcome and pathology findings are comparable with those observed in open and laparoscopy procedures.

Laparoscopic Colectomy

Laparoscopic colectomy can be performed using 2 approaches: lateral or medial. However, it is unknown if one of these techniques provides better results. Thus, the object of the present study is to assess whether one of the approaches has any potential benefits over the other. A comparative, retrospective study was performed that included all patients scheduled for left and right laparoscopic colon resection for both neoplastic and benign diseases between June 2000 and June 2006. The following factors were assessed: operation time, recovery variables (bowel sounds, passage of gases, intake of liquids and solids), length of hospital stay, and morbidity and mortality rates. The population was divided into 4 groups: right colectomy using a lateral approach (RL); right colectomy using a medial approach (RM); left colectomy using a lateral approach (LL); and left colectomy using a medial approach (LM). A total of 202 patients were evaluated: RL: 16 (8%); RM: 37 (18.3%); LL: 110 (54.4%); LM: 39(19.3%). No differences in recovery parameters were observed between the right colectomies. However, the presence of bowel sounds and solid intake was significantly earlier in the patients subjected to left colectomies using a medial approach. A tendency toward a higher conversion rate was observed in left colectomies with lateral approach (LL: 18 vs. LM: 1, P=0.052). The operation time was significantly shorter when a medial approach was used for both right and left colectomies (RL: 185.6 min vs. RM: 148.6 min, P=0.009; LL: 205.5 min vs. LM: 139.9 min, P<0.0001). No differences in the morbidity and mortality rates were found between lateral and medial approach in both types of colectomy. The use of a medial approach in a laparoscopic colectomy provides short-term benefits compared with a lateral approach.