Laparoscopic colectomy in obese and nonobese patients

Obese patients carry a higher risk of wound complications and cardiopulmonary complications along with a higher incidence of comorbidity, all of which have the potential to affect outcome after a variety of surgical procedures. The data regarding outcomes after laparoscopic colectomy in obese and nonobese patients are limited. The purpose of this report was to compare the outcome of laparoscopic bowel resection in obese and nonobese patients. All patients prospectively entered into a laparoscopic bowel resection database from March 1999 to December 2001, who underwent a segmental colectomy for any pathologic condition, were analyzed. Patients with a body mass index above 30 were defined as obese, and patients with a body mass index below 30 were defined as nonobese. Data collected included age, sex, duration of operation, body mass index, American Society of Anesthesiologists score, operative procedure diagnosis, complications relating to length of hospital stay, mortality, and readmission within 30 days of discharge. Statistical analysis consisted of Student’s t test and chi-square analysis where appropriate, with significance set at P < 0.05. A total of 260 patients were evaluated (201 [77.3%] in the nonobese group and 59 [22.7%] in the obese group). There were no significant differences between the two groups with respect to age, sex, operative procedure, length of hospital stay, or readmission rates. The obese group had significantly more conversions to an open procedure (23.7% vs. 10.9%), a longer operative duration (109 minutes vs. 94 minutes), a higher morbidity rate (22% vs. 13%) and a higher anastomotic leakage rate (5.1% vs. 1.2%). This large experience with laparoscopic colectomy for a variety of conditions demonstrates that despite higher conversion rates, an increased risk of pulmonary complications, and anastomotic leakage rates in obese laparoscopic patients that parallel those of open surgery, laparoscopic colectomy can be performed safely in both obese and nonobese patients with the similar benefit of a shorter hospital stay in both groups.     

Laparoscopic Surgery for Patients with Crohn’s Colitis: A Case-matched Study

Introduction The purpose of this study was to compare short and long-term outcomes of laparoscopic colectomy with open colectomy in patients with Crohn’s disease confined to the colon. Materials and Methods We reviewed all patients undergoing laparoscopic colectomy for Crohn’s disease at our institution between 1994 and 2005. Laparoscopic colectomies were matched to open colectomies by patient age, gender, American Society of Anesthesiologists score, type, and year of surgery. We excluded patients with concomitant small bowel disease. Results Twenty-seven laparoscopic cases were matched with 27 open cases. There were seven conversions (26%). There was no mortality. Median operative times were significantly longer after laparoscopic colectomy (240 vs 150 min, P < 0.01), and estimated blood loss was comparable (325 vs 350 ml, P = 0.4). Postoperative complications were similar. Laparoscopic colectomies had shorter median length of stay (5 vs 6 days, P = 0.07) and median time to first bowel movement (3 vs 4 days, P = 0.4). When overall length of stay included 30-day readmissions, the difference in favor of laparoscopy became statistically significant (P = 0.02). Recurrent disease requiring surgery was decreased after laparoscopy, although median follow-up was significantly shorter. Conclusion Laparoscopic colectomy is a safe and acceptable option for patients with Crohn’s colitis. Longer follow-up is needed to accurately establish recurrence rates.     

Increasing the number of attacks increases the conversion rate in laparoscopic diverticulitis surgery

Background  This study aimed to determine whether the number of diverticulitis or complicated diverticulitis episodes affects the conversion rate or postoperative complication rate in elective laparoscopic sigmoid colectomy. Methods  In this study, 216 charts were reviewed for baseline characteristics, diverticulitis history, and intra- and postoperative complications. Analysis was performed with the Student’s t-test, the chi-square test, and Fisher’s exact tests. Results  Of 216 sigmoid colectomies, 151 were laparoscopic, 19 were converted, and 46 were open. Baseline characteristics were similar for patients with zero to two and those with three or more inpatient diverticulitis attacks. Patients with uncomplicated diverticulitis had a higher rate of conversion after three or more inpatient episodes (2.6% vs 25%; p = 0.04). There was no difference in operative times or postoperative complication rates. Patients with a history of abscess had a 23% chance of conversion. Those with no abscess history had an 8% chance of conversion (p = 0.02). In general, converted procedures required more time than open procedures but were associated with decreased hospital length of stay (LOS) and a decreased rate of postoperative ileus. Conclusion  Multiple inpatient diverticulitis attacks and a history of abscess were associated with laparoscopic conversion. Converted procedures required more time than open procedures, but had reduced LOS and postoperative ileus. Laparoscopic sigmoid colectomy can be attempted safely for patients with three or more inpatient attacks or a history of complicated diverticulitis.     

Laparoscopic total colectomy for colorectal cancers: a comparative study

Background No previous report could be found in the literature comparing laparoscopic and open total colectomy for colorectal cancers, especially synchronous colorectal cancers. This study aimed to compare the short-term clinical outcomes and oncologic results of laparoscopic and open total colectomy or proctocolectomy for colorectal cancers. Methods Between July 1997 and January 2005, six patients with colorectal cancers underwent elective laparoscopic total colectomy or proctocolectomy at the authors’ institution. Clinical data for 12 patients who underwent elective open total colectomy or proctocolectomy for colorectal cancers during the same period were prospectively collected and compared. Results The median follow-up periods were 43.9 months for the laparoscopic group and 48.2 months for the open group. Conversion to open procedure was required for one patient (16.7%) in the laparoscopic group because of bleeding. The median operative time was significantly longer in the laparoscopic group (427.5 min; range, 280–480 min vs 172.5 min; range, 90–260 min; p = 0.001). The patients in the laparoscopic group required a significantly shorter duration of parenteral analgesia (3 vs 5 days; p = 0.01), but there were no differences in time to first bowel motion, time to resumption of diet, time to full ambulation, and duration of hospital stay between the two groups. Perioperative morbidity rates were comparable between the two groups, and there was no operative mortality. The oncologic results, including number of lymph nodes removed, recurrence rates, and survival rates, were similar in the two groups. Conclusions Laparoscopic total colectomy has short-term clinical outcomes (postoperative recovery and perioperative morbidity and mortality rates) and oncologic results similar to those of open surgery for treating patients with colorectal cancers. Our study has shown that the only advantage of laparoscopic over open surgery is a shorter duration of analgesic requirement, but at the expense of a longer operative time.     

Trends in utilization and outcomes of laparoscopic versus open appendectomy

BACKGROUND: Although a number of trials have analyzed the outcomes of laparoscopic versus open appendectomy, the clinical advantages, and cost-effectiveness of laparoscopic appendectomy in the management of acute and perforated appendicitis are still not clearly defined. The aim of this study was to examine utilization and outcomes of laparoscopic versus open appendectomy using a national administrative database of academic medical centers and teaching hospitals. METHODS: Using ICD-9 diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent appendectomy for acute and perforated appendicitis between 1999 and 2003 (n = 60,236). Trends in utilization of laparoscopic appendectomy were examined over the 5-year period. The outcomes of laparoscopic and open appendectomy were compared including length of hospital stay, 30-day readmission, complications, observed and expected (risk-adjusted) in-hospital mortality, and costs. RESULTS: Overall, 41,085 patients underwent open appendectomy and 19,151 patients underwent laparoscopic appendectomy. The percentage of appendectomy performed by laparoscopy increased from 20% in 1999 to 43% in 2003 (P <0.01). Compared with patients who underwent open appendectomy, patients who underwent laparoscopic appendectomy were more likely female, more likely white, had a lower severity of illness, and were less likely to have perforated appendicitis. Laparoscopic appendectomy was associated with a shorter length of hospital stay (2.5 days vs 3.4 days), lower rate of 30-day readmission (1.0% vs 1.3%), and lower rate of overall complications (6.1% vs 9.6%). There was no significant difference in the observed to expected mortality ratio between laparoscopic and open appendectomy (0.5 vs 0.6, respectively). The mean cost per case was similar between the two groups (US$ 6,242 vs US$ 6,260). CONCLUSIONS: Utilization of laparoscopic appendectomy at academic centers has increased more than two-fold between 1999 and 2003. Patients selected for laparoscopic appendectomy have less advanced appendicitis and have a shorter length of stay and fewer complications without increasing the inpatient care cost.     

A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases

BACKGROUND: A critical outcome analysis of a large, single-institution experience provides a better frame of reference for an assessment of the role of laparoscopic colectomy for colorectal pathology. METHODS: Review of a prospectively gathered database was performed of a consecutive series of laparoscopic colectomy patients who were operated on by 2 surgeons at a single institution (tertiary referral center) using standardized techniques and care plans. Patients were assessed for operative indications, type of resection, operative time, conversion, complications, duration of stay, and readmission within 30 days. RESULTS: One thousand consecutive patients undergoing laparoscopic colectomy from January 1999 thru June 2004 were analyzed. The types of resections were right colectomy = 314, left/sigmoid colectomy/anterior resection = 435, total colectomy = 61, total proctocolectomy = 14, and other = 176. The indications for surgery were diverticular disease = 285, colorectal neoplasia = 285, inflammatory bowel disease = 172, rectal prolapse = 81, and other = 177. The conversion rate was 11.4%. The mean operative time was 112 +/- 45 minutes for all resections. The mean duration of hospitalization for all patients was 3.7 +/- 3.8. The overall complication rate was 9.9%, with the most frequent complications being ileus 2.8%, pulmonary 1.6%, cardiac 1.4%, and wound infection 2.6%. The 30-day readmission rate was 9.1%, and the most frequent reasons for readmission were ileus/small-bowel obstruction, intra-abdominal infection, and anastomotic leak. CONCLUSIONS: This largest single-institution experience with laparoscopic colectomy confirms the benefits of a standardized approach including shorter hospital rehabilitation and low rates of cardiopulmonary and wound complications. Efforts must be directed at improving access to training in laparoscopic colectomy techniques so that patients can benefit from this new technology.     

Laparoscopy should be the approach of choice for acute appendicitis in the morbidly obese

BACKGROUND: The current study compared the outcome of morbidly obese patients undergoing laparoscopic versus open appendectomy. METHODS: We obtained data from the University HealthSystem Consortium (UHC) database on 1,943 morbidly obese patients who underwent appendectomy for acute or perforated appendicitis between 2002 and 2007. RESULTS: Compared to open appendectomy, laparoscopic appendectomy was associated with a shorter length of stay (3 vs 4 days) and a lower overall complication rate (9% vs 17%). Most notably, a lower rate of wound infection was noted (1% vs 3%). Within a subset analysis of morbidly obese patients who underwent appendectomy for perforated appendicitis, there was a higher overall complication rate (27% vs 18%) and cost ($16,600 vs $12,300) in the open appendectomy group. CONCLUSION: In the morbidly obese, laparoscopic appendectomy performed for acute and perforated appendicitis is associated with a shorter length of stay and lower morbidity and costs. Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in the morbidly obese population.     

Outcomes of right and left colectomy at academic centers

Few studies have compared outcomes of right colectomy (RC) and left colectomy (LC) with respect to both benign and malignant disease. The objective of this study was to compare outcomes of RC versus LC for benign and malignant disease using a national administrative database of academic medical centers. Using International Classification of Diseases, 9th Revision diagnosis and procedure codes, data was obtained from the University HealthSystem Consortium Clinical Data Base for patients that underwent RC and LC for benign and malignant disease between 2002 and 2006. The main outcomes compared were demographics, length of hospital stay, observed to expected in-hospital mortality, complications, 30-day readmission, and mean cost. There were a total of 27,483 patients; 12,971 patients (47.2%) underwent RC. Compared with LC for benign disease, RC was associated with a shorter length of stay, lower overall complications, lower wound infections, lower 30-day readmissions, and lower cost. Compared with LC for malignant disease, RC was associated with lower overall complications, lower wound infections, and lower cost. In this analysis of academic centers, RC was associated with a lower length of stay, lower morbidity, and lower cost when compared with LC for benign and malignant disease.     

Outcomes of laparoscopic and open colectomy at academic centers

BACKGROUND: Laparoscopic techniques have emerged as a suitable approach for colon resection. This study determined and compared the outcomes of patients undergoing laparoscopic or open colectomy at United States academic centers. METHODS: Using ICD-9-CM codes, we obtained data from the University HealthSystem Consortium database for 50,443 patients who underwent open (n = 47,090; 94%) or laparoscopic (n = 3,353; 6%) colectomy during a 5-year period (2002 to 2006). Outcomes studied included length of stay (LOS), costs, in-hospital morbidity and risk-adjusted mortality rates. RESULTS: Mean LOS (open = 11 days and laparoscopic = 7 days) was significantly shorter and mean costs (open = $23,000 and laparoscopic = $17,000) significantly fewer with the laparoscopic approach. The overall in-hospital morbidity rate was significantly lower with laparoscopic colectomy (open = 33% and laparoscopic = 24%). The risk-adjusted mortality ratio was comparable between groups (open = .9 and laparoscopic = .7). Comments: Despite the major biases inherent in this retrospective review of the University Health System Consortium, which favors the use of laparoscopic colectomy by United States academic surgeons, laparoscopic colectomy offers the potential of significantly shorter LOS, fewer costs, lower in-hospital morbidity rates, and comparable risk-adjusted mortality rates compared with open colectomy. Laparoscopic colectomy is as safe as the open approach.     

Laparoscopic total colectomy and ileorectal anastomosis (IRA), supported by an enhanced recovery programme in cases of familial adenomatous polyposis

Aim Familial adenomatous polyposis (FAP) is associated with an almost 100% chance of colorectal cancer by the age of 50 years. Surgery is the only prophylaxis. The study compared the outcome of prophylactic laparoscopic colectomy and ileorectal anastomosis (IRA) with conventional open surgery. Method A case–control study was carried out including all cases of proven FAP undergoing prophylactic laparoscopic colectomy with IRA between 1 April 2006 and 31 March 2008 using a standardized technique within an enhanced recovery programme (ERAS). All data were collected prospectively. Controls were identified retrospectively from patients who underwent open prophylactic IRA before 31 March 2008 and were matched for age, gender, BMI and ASA. Outcomes included duration of surgery, complications, length of stay, readmission and mortality. Results During the study period 25 patients underwent laparoscopic IRA. The median operating time was longer in the laparoscopic group (235 vs 180 mins, P < 0.0001) but the median hospital stay was shorter (6 vs 9 days, P = 0.002). Overall there were fewer complications in the laparoscopic group (20%vs 40%, P = 0.3). Conclusion Laparoscopic prophylactic colectomy with IRA in FAP is safe and feasible, and combined with ERAS leads to accelerated recovery and possibly fewer complications than open surgery. FAP patients undergoing prophylactic IRA should be offered laparoscopic surgery.     

Telerobotic surgery for right and sigmoid colectomies: 30 consecutive cases

Background This study aimed to evaluate the feasibility of using a robotic assistant for colon resections. This report describes the experience, advantages, and disadvantages of using the DaVinci system for a colectomy on the basis of 30 consecutive cases managed by a minimally invasive surgery fellowship–trained surgeon. Methods Data were prospectively collected on 30 consecutive colectomies performed using the DaVinci system from September 2002 to March 2005. Results A total of 13 sigmoid colectomies with splenic flexure mobilization and 17 right colectomies were performed for 14 men and 16 women. The preoperative diagnoses for the procedures were cancer (n = 5), diverticulitis (n = 8), polyps (n = 16), and carcinoid (n = 1). The right colectomies required 29.7 ± 6.7 min (range, 22–44 min) for the port setup, 177.1 ± 50.6 min (range, 103–306 min) for the robot, and 218.9 ± 44.6 min (range, 167–340 min) for the total case. The length of stay was 5.2 ± 5.8 days (range, 2–27 days). The robot portion was 80.9% of the total case time. The sigmoid colectomies required 30.1 ± 9.6 min (range, 15–50 min) for the port setup, 103.2 ± 29.4 min (range, 69–165 min) for the robot, and 225.2 ± 37.1 min (range, 147–283 min) for the total case. The hospital length of stay was 6.0 ± 7.3 days (range, 3–30 days). The robot portion was 45.8% of the total case time. Six complications occurred: left hip paresthesia, cecal injury, anastomotic leak, patient slipped from the operating table after the robotic portion of the case, transverse colon injury, and return of a patient to the office with urinary retention. Two sigmoid colectomies were converted to laparotomy. The specific advantages and disadvantages of using the DaVinci system for colectomies are discussed. Conclusions The 30 consecutive cases demonstrated the technical feasibility of using the DaVinci system for a colectomy. The longevity of the DaVinci system’s use for colectomy will be determined by comparison of its cost and outcomes with those for conventional laparoscopic colectomy.     

Laparoscopic and Open Distal Pancreatic Resection for Benign Pancreatic Disease

The aim of the study is to provide comparisons of the perioperative outcomes between open and laparoscopic distal pancreatic resection (DPR) for benign pancreatic disease. From 2002 and 2005, there were 28 patients (16 open, 12 laparoscopic) with a mean age of 52 who had presumptive diagnoses of benign pancreatic lesions. Pathology was neuroendocrine tumor (nine and five), mucinous cystic neoplasm (three and three), symptomatic pancreatic pseudocyst (two and two), and others (two and two). The mean operative time was 278 vs 212 min (p = 0.05), the estimated blood lost was 609 vs 193 ml (p = 0.01), and the success rate of preoperative intent for splenic preservation was 17 vs 62% (p = 0.08) in the open and laparoscopic groups, respectively. Two patients (16%) were converted to an open procedure. There was no perioperative mortality. The mean hospital stay and total perioperative morbidity were 10.6 vs 6.2 days (p = 0.001) and nine vs two events (p = 0.03) in the open and laparoscopic groups, respectively. Ten of 12 patients (83%) with laparoscopic DPR had adequate oral intake within 72 h post operatively in contrast to 2 of 16 (12.5%) patients in the open DPR group (p = 0.0001). Laparoscopic DPR is technically feasible, safe, and associated with less perioperative morbidity and a shorter hospital stay than open DPR. In centers with the appropriate expertise, laparoscopic DPR should be considered the procedure of choice for putative benign lesions of the pancreatic body and tail. Presented at the AHPBA Spring Meeting, Miami Beach, FL March 9–12, 2006 (oral presentation)     

Hand-assisted laparoscopic sigmoid colectomy: helping hand or hindrance?

Background Hand-assisted laparoscopic colectomy has been introduced as an alternative to the standard laparoscopic technique, but it has not yet been established whether it offers the same benefits. Therefore, we compared the outcome of patients undergoing hand-assisted laparoscopic sigmoid resection (HALSR) to that of those undergoing laparoscopic sigmoid resection (LSR).Methods The study population comprised a sequential series of consecutive patients undergoing elective laparoscopic sigmoid/left colectomy. Values are reported as mean (range).Results There were 85 LSR patients and 66 HALSR patients, with no differences in patient demographics or diagnoses. There were slight differences in operative time favoring HALSR (LSR 205 min (90–380) vs HALSR 189 min (120–290); p = 0.07), and the extraction incision was larger in the HALSR group (LSR 6.2 cm (3–25) vs HALSR 8.1 cm (7–12); p < 0.01). There was no difference in time for return of bowel function (LSR 2.8 days (1–15) vs HALSR 2.5 days (1–8); p = 0.31) or length of hospital stay (LSR 5.0 days (2–17) vs HALSR 5.2 days (3–22); p = 0.73). Complications were similar in the two groups (LSR 23% vs HALSR 21%), but there were fewer conversions in the hand-assisted group (HALSR 0% vs LSR 13%; p < 0.01).Conclusions Hand-assisted laparoscopic sigmoid resection yields the same outcomes as standard laparoscopic techniques, but with fewer conversions. Hand-assistance is a helpful innovation that may expand the application of laparoscopic colectomy.Presented at the scientific session of the annual meeting of the society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, CO, USA, 3 April 2004     

Emergency laparoscopic colectomy: does it measure up to open?

Background

Laparoscopic colectomy has become the standard of care for elective resections; however, there are few data regarding laparoscopy in the emergency setting.

Methods

By using a database with prospectively collected data, we identified 94 patients who underwent an emergency colectomy between August 2005 and July 2008. Laparoscopic surgeries were performed in 42 patients and were compared with 25 patients who were suitable for laparoscopy but received open colectomy.

Results

The groups had similar demographics with no differences in age, sex, or surgical indications. Blood loss was lower (118 vs 205 mL; P < 0.01) and the postoperative stay was shorter (8 vs 11 d; P = 0.02) in the laparoscopic patients, and perioperative mortality rates were similar between the 2 groups (1 vs 3; P = 0.29).

Conclusions

With increasing experience, laparoscopic colectomy is a feasible option in certain emergency situations and is associated with shorter hospital stay, less morbidity, and similar mortality to that of open surgery.     

Robot-assisted laparoscopic colectomy: 70 cases—one surgeon

This study reviewed the use of robot-assisted laparoscopic surgery for colon resection. We described the six-year experience of one minimally invasive fellowship-trained surgeon performing 70 consecutive colectomies using the da Vinci system. Between September 2002 and 2007, data on 70 patients undergoing robotic colectomy for diverticular disease, polyps, cancer, or carcinoid tumor were collected. Operations were right colectomy and sigmoid colectomy. A total of 38 right and 32 sigmoid colectomies were performed in 32 males and 38 females. The postoperative diagnoses were diverticular disease (19), polyps (36), cancer (13), and carcinoid (2). Times for the right colectomies were: port setup time 33.6 ± 12.1 (20–64) min, robotic time 147.2 ± 44.4 (53–306) min, and total case time 221.3 ± 43.7 (150–380) min. The estimated blood loss (EBL) was 53.9 ± 78.2 (15–500) ml, the body mass index (BMI) 27.2 ± 4.2 (17–36.8) kg/m², and the median length of stay (LOS) 3 (2–27) days. The robotic portion represented 66.5 % of the total case time. Times for the sigmoid colectomies were: port setup time 30.0 ± 9.8 (10–57) min, robotic time 101.8 ± 25.3 (67–165) min, and total case time 228.4 ± 40.5 (147–323) min. The EBL was 71.2 ± 47.9 (15–200) ml, the BMI 27.1 ± 4.9 (17.0–40.5) kg/m², and the median LOS 4 (2–27) days. The robotic portion represented 44.6% of the total case time. Eight different types of complication occurred. Eight cases were converted—five to open and three to laparoscopic. Two resulted from robot malfunction. Residents participated in 40 cases (57.1%). In the years 2002–2006, respectively, 5, 12, 10, 11, and 19 robotic colectomies were performed. In the first nine months of 2007, 13 robotic colectomies were performed. These 70 consecutive cases have demonstrated robotic colectomy to be a safe and technically feasible approach. The number of robotic colectomies performed each year has steadily increased over the last six years. This series compared favorably with other robotic series in length of hospital stay, conversion rates, and total case time.     

Laparoscopic gastric bypass for gastric outlet obstruction is associated with smoother, faster recovery and shorter hospital stay compared with open surgery

Background/Purpose Laparoscopic gastric bypass for relief of gastric outlet obstruction (GOO) is feasible and safe. However, comparative data to confirm the benefits of the laparoscopic approach remain scarce. Methods Between 1998 and 2003, 26 patients underwent 15 laparoscopic (surgeon A) and 12 open (surgeon B) gastrojejunostomies (GJs) for GOO. The indications for surgery included malignant (n = 17) and benign (n = 10) diseases. Results There were no conversions to open surgery in the laparoscopic group, and no operative mortality occurred in either group. The groups were comparable for age, sex, American Society of Anesthesiology (ASA) score, frequencies of previous abdominal surgery and of malignant or benign disease, and type of GJ fashioned. There were no differences between the laparoscopic and open groups with regard to the operating time (median, 90 vs 111 min; P = 0.113), and patients receiving intraoperative blood transfusion. However, laparoscopic surgery was associated with significantly shorter durations of postoperative intravenous hydration (60 vs 234 h; P = 0.001), opiate analgesia (49 vs 128 h; P = 0.025), and hospital stay (3 vs 15 days; P = 0.005). Operative morbidity occurred more frequently following open surgery (33% vs 13%; P = 0.219). Conclusions Laparoscopic GJ for the relief of GOO is associated with a smoother and more rapid postoperative recovery and shorter hospital stay compared with open surgery. In experienced hands, the laparoscopic approach to GJ should become the new gold standard.     

Hospital Discharge in the Day Following Open Roux-en-Y Gastric Bypass: Is it Feasible and Safe?

Background  Roux-en-Y gastric bypass (RYGBP) either laparoscopic or open has been increasingly employed in the treatment of patients with morbid obesity. Laparoscopic approach is believed to be superior over open approach in terms of shorter hospital stay and easier recovery. We aimed to assess feasibility and safety of open RYGBP with short stay in comparison with laparoscopic RYGBP. Methods  One hundred and ninety consecutive patients were assigned to open (n = 103) or laparoscopic (n = 87) RYGBP. The first 20 patients of the laparoscopic arm were excluded due to procedure learning curve. Patients were treated by a multidisciplinary team focused on successfully RYGBP with short stay (1 day). Results  Short stay was reached by 90% of patients operated with open approach and 81% by laparoscopy (P = 0.070). Discharge in the second day was reached by 97% of patients in both groups. Procedure length [(median (IQR)] was faster for open RYGBP [103 (70–180 min) vs. 169 (105–248 min); P < 0.0001]. Thirty-day readmission rate was similar between groups (3% vs. 7%; P = 0.266). There was no death in either group. Conclusion  Short stay (1 day) following open gastric bypass was a feasible and safe procedure. This approach might have economic impact and might increase patient acceptance for open RYGBP.     

Utilization of laparoscopy in colorectal surgery for cancer at academic medical centers: does site of surgery affect rate of laparoscopy?

Use of laparoscopy in colorectal cancer surgery is still limited. The aim of this study was to determine the rate of use of laparoscopic colorectal surgery for cancer at academic medical centers and to evaluate if the site of surgery influences the rate of use. Clinical data of patients who underwent laparoscopic or open colon and rectal resections for cancer from 2007 to 2009 were obtained from the University HealthSystem Consortium database. Data concerning rate of laparoscopy, length of stay, morbidity, and risk-adjusted mortality were obtained. During the 36-month study period, 22,780 operations were performed. The overall rate for use of laparoscopy was 14.8 per cent. Laparoscopy was most often used for total colectomy (22.6%), sigmoid colectomy (17.3%), cecectomy (17.1%), and right hemicolectomy (17.0%). Laparoscopy was most infrequently used for abdominoperineal resection (8.0%), transverse colectomy (10.0%), and left hemicolectomy (13.1%). Length of stay for laparoscopic colon and rectal procedures was 3.2 days shorter than for open surgery. Although the benefits of laparoscopic colorectal surgery for cancer have been demonstrated, the use of laparoscopy for colorectal resection remains under 20 per cent for colon cancer and under 10 per cent for rectal cancer. Further studies are needed to determine the factors limiting the use of laparoscopy in colorectal surgery.     

Laparoscopic Colonic Resection for Rectosigmoid Colonic Tumours: A Retrospective Analysis and Comparison with Open Resection

Laparoscopic approach for treatment of colorectal malignancy is gaining acceptance gradually; however the benefits of laparoscopic surgery in colonic and rectal tumours is still open to debate. This study aims at a retrospective analysis of operative and short term outcome of patients with rectosigmoid tumours. A retrospective analysis of operative, postoperative and short-term outcome of 62 patients who underwent laparoscopic colorectal resection for cancer of rectosigmoid region were compared with a same number of parameters-matched patients who underwent open colorectal resection. Blood transfusion requirement was significantly more in the open group compared to the laparoscopy group (38.7% versus 6.4%, p = 0.001). ICU stay was less in the laparoscopy group (p = <0.05) and they were started on oral liquid diet earlier (p = 0.013). The number of the lymph nodes retrieved, positive distal margin and radial involvement were similar in both groups. The hospital stay was significantly shorter in laparoscopy group (8.4 versus 13.8 days, p < 0.05). Radical operation for rectosigmoid tumors is technically feasible with laparoscopic surgery. Laparoscopic approach is associated with less blood loss, transfusion and significantly less ICU stay. Laparoscopic group recovers early and needs less hospital stay     

Laparoscopic colorectal surgery – results from 200 patients

OBJECTIVE: Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short-term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years. METHOD: A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest. RESULTS: Two hundred and thirty-one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter-quartile range (IQR) 57-76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90-150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15-30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re-operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3-6) and 13 patients (6.5%) were re-admitted within 30 days of hospital discharge. CONCLUSION: Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.