scholarly journals Comparison of defecatory function after laparoscopic total colectomy and ileorectal anastomosis versus a traditional open approach

2018 ◽  
Vol 100 (3) ◽  
pp. 235-239 ◽  
Author(s):  
MAS Khan ◽  
D Jayne ◽  
R Saunders
Keyword(s):  
Colorectal Cancer ◽  
Small Bowel ◽  
Ileorectal Anastomosis ◽  
Total Colectomy ◽  
Postoperative Bleeding ◽  
Laparoscopic Approach ◽  
Paediatric Surgery ◽  
Open Approach ◽  
Defecatory Function ◽  
Significant Difference

Introduction Total colectomy and ileorectal anastomosis can result in significant defecatory frequency and poor bowel function. The aim of this study was to assess whether a laparoscopic approach is associated with any improvement in this regard. Methods A single institution retrospective review was undertaken of patients undergoing elective total colectomy and ileorectal anastomosis between 2000 and 2011. Those undergoing emergency surgery and paediatric surgery were excluded. The primary outcome measure was satisfactory defecatory function after surgery. Results Forty-nine patients (24 male, 25 female) were included in the study. The median age was 48 years (range: 20–83 years). Laparoscopic total colectomy (LTC) was performed in 20 patients and open total colectomy (OTC) in 29 patients. Indications for surgery were slow colonic transit (n=17), colorectal cancer (CRC) (n=17), CRC with hereditary colorectal cancer syndrome (n=8), inflammatory bowel disease (n=4) and diverticular disease (n=3). In the LTC group, 85% had a satisfactory defecatory frequency of 1–6 motions per day compared with 45% in the OTC cohort (p=0.006). There was no statistically significant difference in bowel frequency related to primary pathology (benign vs cancer surgery, p=1.0). Postoperative complications for both groups included relaparotomy (n=3), anastomotic leak (n=2), small bowel obstruction (n=2), postoperative bleeding (n=1) and pneumonia (n=1). Conclusions This study indicates that long-term defecatory function is better following LTC than following OTC and ileorectal anastomosis. The mechanism for this improvement is unclear but it may relate to the underlying reason for surgery or possibly to reduced small bowel handling leading to fewer adhesions after laparoscopic surgery.

scholarly journals Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

2019 ◽  
Vol 8 (6) ◽  
pp. 875 ◽  
Author(s):  
Chong-Chi Chiu ◽  
Wen-Li Lin ◽  
Hon-Yi Shi ◽  
Chien-Cheng Huang ◽  
Jyh-Jou Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Metastatic Colorectal Cancer ◽  
Surgical Complications ◽  
Open Surgery ◽  
Tumor Recurrence ◽  
Laparoscopic Approach ◽  
Open Approach ◽  
Significant Difference

The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.

scholarly journals Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

2019 ◽  
Author(s):  
Chong-Chi Chiu ◽  
Wen-Li Lin ◽  
Hon-Yi Shi ◽  
Chien–Cheng Huang ◽  
Jyh-Jou Chen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Metastatic Colorectal Cancer ◽  
Tumor Recurrence ◽  
Statistical Significance ◽  
Laparoscopic Approach ◽  
Open Approach ◽  
Elective Resection ◽  
Significant Difference

The oncologic merits of laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by only one surgeon in a medical institution were randomized to either laparoscopic or open treatment. During this period, total 188 patients received laparoscopic surgery and other 163 patients to open approach. The primary endpoint was cancer-free 5-year survival after operative treatment and secondary endpoint was the tumor recurrence incidence. We found there was no statistically significant difference between open and laparoscopic groups regarding average number of lymph nodes dissected, overall mortality rate, cancer recurrence rate or cancer-free 5-year survival. Nevertheless, laparoscopic approach was more effective for colorectal cancer treatment with shorter hospital stay and less blood loss despite operation time was significantly longer. Meanwhile fewer patients receiving laparoscopic approach developed postoperative urinary tract infection, wound infection, pneumonia or anastomosis leakage, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes whether in total complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free 5-year survival and tumor recurrence, we favor patients receiving laparoscopic surgery if not contraindicated.

scholarly journals Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
C. G. Ker ◽  
J. S. Chen ◽  
K. K. Kuo ◽  
S. C. Chuang ◽  
S. J. Wang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Average Length ◽  
Survival Rates ◽  
Laparoscopic Approach ◽  
Operation Time ◽  
Open Approach ◽  
Full Diet ◽  
Or Groups ◽  
Significant Difference

In this study, we try to compare the benefit of laparoscopic versus open operative procedures.Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized.Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.

Role of Laparoscopic Surgery in the Current Management of Mirizzi Syndrome

2018 ◽  
Vol 84 (5) ◽  
pp. 667-671 ◽  
Author(s):  
Rondi Gelbard ◽  
Desmond Khor ◽  
Kenji Inaba ◽  
Obi Okoye ◽  
Crystal Szczepanski ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Open Cholecystectomy ◽  
Disease Process ◽  
Laparoscopic Approach ◽  
Mirizzi Syndrome ◽  
Open Approach ◽  
Significant Difference ◽  
Care Surgery

Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis caused by extrinsic biliary compression by stones in the gallbladder infundibulum or cystic duct. The purpose of this study was to evaluate the outcomes associated with a laparoscopic approach to this disease process. This is a 10-year, retrospective study conducted at two academic medical centers with established acute care surgery practices. Patients with a diagnosis of MS confirmed intraoperatively were included. Eighty-eight patients with MS were identified with 55 (62.5%) being type 1. Twenty six (29.5%) patients, all type 1, underwent successful laparoscopic cholecystectomy. Of the 62 patients that underwent open cholecystectomy, 27.3 per cent had a laparoscopy converted to open procedure. There was no significant difference in overall complications (19.2 vs 29%) among those undergoing laparoscopic versus open cholecystectomy. Length of stay was lower in patients that had a laparoscopic approach ( P = 0.001). Laparoscopic cholecystectomy can safely be attempted in type 1 MS and seems to be associated with fewer overall complications and shorter length of stay compared with an open approach.

Optimizing Patient Selection for Laparoscopic and Open Colorectal Cancer Resections: A National Surgical Quality Improvement Program–Matched Analysis

2019 ◽  
Vol 85 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Anne Sophie H. M. Van Dalen ◽  
Usama Ahmed Ali ◽  
Alice C. A. Murray ◽  
Ravi Pokala Kiran
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Interaction Analysis ◽  
Laparoscopic Approach ◽  
Patient Characteristics ◽  
Laparoscopic Technique ◽  
Open Approach ◽  
Improvement Program ◽  
Wide Range ◽  
Nonobese Patients

The aim of this study was to identify patients undergoing colorectal cancer (CRC) resection who might benefit specifically from either an open or laparoscopic approach. From the NSQIP database (2012–2013), patients who underwent laparoscopic colectomy (LC) or open colectomy (OC) for CRC were identified. The two groups were matched and compared in terms of any, medical, and surgical complications. A wide range of patient characteristics were collected and analyzed. Interaction analysis was performed in a multivariable regression model to identify risk factors that may make LC or OC more beneficial in certain subgroups of patients. Overall, OC (n = 6593) was associated with a significantly higher risk of any [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.87–2.20], surgical (OR 1.98, 95% CI 1.82–2.16), and medical (OR 1.71, 95% CI 1.51–1.94) complications than LC (n = 6593). No subgroup of patients benefited from an open approach. Patients with obesity (BMI > 30) (P = 0.03) and older age (>65 years) (P = 0.01) benefited more than average from a laparoscopic approach. For obese patients, LC was associated with less overall complications (OC vs LC: OR 1.92 obese vs 1.21 nonobese patients). For elderly patients, LC was more preferable regarding the risk of medical complications (OC vs LC OR of 1.91 vs 1.34 for younger patients). No subgroup of CRC patients benefited specifically more from an open colorectal resection. This supports that the laparoscopic technique should be performed whenever feasible. For the obese and elderly patients, the benefits of the laparoscopic approach were more pronounced.

scholarly journals 559 One Mesenteric Defect, Two Segments of Colon, A Number of Surgical Strategies! A Rare Case of An Internal Hernia Causing Bowel Ischemia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Devani ◽  
N Al-Saadi ◽  
D Bowrey
Keyword(s):  
Small Bowel ◽  
Sigmoid Colon ◽  
Internal Hernia ◽  
Laparoscopic Approach ◽  
Signs And Symptoms ◽  
High Morbidity ◽  
Sigmoid Colectomy ◽  
Open Approach ◽  
Mesenteric Defect ◽  
Surgical Strategies

Abstract Internal hernias due to mesenteric defects are a rare cause of bowel obstruction, but once present their complications are associated with a high morbidity and mortality. We present the case of a 24-year-old patient who presented to the emergency department with signs and symptoms of an acute abdomen. Following surgical review, taking into consideration the patient’s clinical, biochemical, and radiological findings, the patient was taken for immediate emergency surgical exploration. A laparoscopic approach was initially taken, which revealed dilated and ischemic colon, and therefore an open approach was then adopted. Operative findings included a very mobile caecum and proximal ascending colon which had herniated through a defect in the small bowel mesentery, the sigmoid colon had subsequently become incarcerated by the caecum and small bowel too. Both the ascending and sigmoid colon had become ischemic. A number of surgical strategies were considered, and given the patients age it was decided to preserve as much normal bowel as possible. Thus, a right hemi- and sigmoid colectomy were performed with an ileo-transverse anastomosis and formation of an end colostomy. In this case, radiological diagnosis pointed to a suspicion of an internal hernia, and operative diagnosis highlighted a rare mesenteric defect causing herniation and subsequent ischemia. Relying on the patient’s clinical condition and an early decision for surgical intervention resulted in a positive outcome for outpatient. The patient made a good recovery following the bowel preserving surgery.

Incidence of methacronous cancer after total colectomy with ileorectal anastomosis or total proctocolectomy in classical FAP patients.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 646-646
Author(s):  
Samuel Aguiar ◽  
Paulo Roberto Stevanato ◽  
Fabio Oliveira Ferreira ◽  
Erika Maria Monteiro Santos ◽  
Ranyell Spencer Sobreira Batista ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ileal Pouch ◽  
Ileorectal Anastomosis ◽  
Total Colectomy ◽  
Salvage Surgery ◽  
Dentate Line ◽  
Hereditary Colorectal Cancer ◽  
Total Proctocolectomy ◽  
Adenomatous Polyposis ◽  
Rectal Anastomosis

646 Background: Total proctocolectomy (TPC) with ileal pouch is considered the procedure of choice in classic familial adenomatous polyposis (FAP), but total colectomy (TC) with rectal sparing can be performed in selected cases. The objective of this study is to determine and compare the incidence of methacronous cancer in the remanescent rectum in patients submitted to TPC or TC. Methods: We performed a retrospective analysis of 55 patients operated beteween 1992 and 2011. Patients were identified from 34 FAP families, registered at the AC Camargo Hereditary Colorectal Cancer Registry. Patients with attenuated FAP were excluded. The main endpoint was the occurence of cancer at the remanescent rectum. Results: Thirty seven patients were submitted to TPC and 18 to TC with ileo-rectal anastomosis. Among patients submitted to TPC, just one (2.7%) had methacronous adenocarcinoma just above the dentate line. Among patients submitted to TC with rectal sparing, 4 (22.2%) have another cancer at the remanescente rectum. This difference was statistically significant (0.035). The stage was initial in all cases, and all patients were submitted to salvage surgery. No deaths related to rectal cancer had occured. Conclusions: Surgical treatment of classical FAP still remains proctocolectomy with ileal pouch, whenever possible. Considering that methacronous cancer uses to be detected in initial stages, rectal sparing can be considered in very selected cases of classical FAP.

scholarly journals Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

2016 ◽  
Vol 106 (1) ◽  
pp. 28-33 ◽  
Author(s):  
T. Hackenberg ◽  
P. Mentula ◽  
A. Leppäniemi ◽  
V. Sallinen
Keyword(s):  
Small Bowel ◽  
Propensity Score ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Open Surgery ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Adhesive Small Bowel Obstruction ◽  
Open Approach ◽  
Laparoscopic Adhesiolysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

scholarly journals CRS and HIPEC in patients with peritoneal metastasis secondary to colorectal cancer: The small-bowel PCI score as a predictor of survival

2019 ◽  
Vol 4 (4) ◽  
Author(s):  
John Spiliotis ◽  
Vasileios Kalles ◽  
Ioannis Kyriazanos ◽  
Alexios Terra ◽  
Anastasia Prodromidou ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Small Bowel ◽  
Peritoneal Metastasis ◽  
Peritoneal Cancer Index ◽  
Patient Characteristics ◽  
Peritoneal Cancer ◽  
Significant Difference ◽  
Crs And Hipec ◽  
The Mean

AbstractBackgroundCombining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. The present study evaluates the small bowel subset of the Peritoneal Cancer Index (Small-Bowel-PCI score (SB-PCI), min-max 0–12) as a prognostic factor in such patients.MethodsWe retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastasis. Patient characteristics, procedure details, and clinical outcomes were evaluated.ResultsEighty patients were included. The mean intraoperative PCI-score was 16.8, with a mean SB-PCI score of 5.9. CC0/1 was achieved in 62/80 patients. The mean follow-up period was 26.3 months. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs. mitomycin-C), the PCI score, the SB-PCI score and the completeness of cytoreduction correlated significantly with overall survival. In multivariate analysis, the SB-PCI and CC score were identified as independent prognostic factors of survival. When the SB-PCI was stratified in three groups (0–4, 5–8 and 9–12), Kaplan–Meier curve analysis showed significant difference in survival (p<0.001).ConclusionsThe SB-PCI correlates with overall survival in patients with peritoneal metastases secondary to colorectal cancer in this retrospective cohort. Its use should be validated in prospective patient series.

scholarly journals Laparoscopic Intervention to Pancreatic Pseudocyst Confers Short-Term Benefits: A Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yulin Guo ◽  
Shun Hu ◽  
Shuo Wang ◽  
Ang Li ◽  
Feng Cao ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Pseudocyst ◽  
Surgical Intervention ◽  
Operating Time ◽  
Surgical Techniques ◽  
Laparoscopic Approach ◽  
Cochrane Library ◽  
Open Approach ◽  
Qualitative Synthesis ◽  
Significant Difference

Background. Surgical interventions for pancreatic pseudocyst (PP) are traditionally managed by an open surgical approach. With the development of minimally invasive surgical techniques, a laparoscopic surgical approach for PPs has been conducted increasingly with comparable outcomes. The present study was conducted to compare the efficacy and safety of surgical intervention for PPs between the laparoscopic approach and the open approach. Methods. Databases including Cochrane Library, PubMed, and EMBASE were searched to identify studies that compared the safety and efficacy of surgical intervention for PPs between the laparoscopic approach and the open approach (until Aug 1st 2020). Results. A total of 6 studies were eligible in qualitative synthesis. The laparoscopic approach was associated with less intraoperative blood loss (MD = −69.97; 95% CI: −95.14 to −44.70, P < 0.00001 ; P = 0.86 for heterogeneity) and shorter operating time (MD = −33.12; 95% CI: −62.24 to −4.00, P = 0.03 ; P < 0.00001 for heterogeneity). There was no significant difference found between the two approaches regarding the success rate and the recurrence rate. The postoperative complications and mortality rates were comparable between the two approaches. Conclusions. The laparoscopic approach for the surgical intervention of PPs is safe and efficacious with shorter-term benefits.

Sign in / Sign up

Export Citation Format

Share Document