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1.
Karen Chang Mathew Fakhoury Moshe Barnajian Cristi Tarta Roberto Bergamaschi 《Surgical endoscopy》2013,27(5):1730-1736
Background
This study was performed to evaluate short-term clinical outcomes of laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon.Methods
This was a retrospective study of selected patients who underwent laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon for tumors or Crohn’s disease by a single surgeon from July 2002 through June 2012. Data were retrieved from an Institutional Review Board-approved database. Study end point was postoperative adverse events, including mortality, complications, reoperations, and readmissions at 30 days. Antiperistaltic side-to-side anastomoses were fashioned laparoscopically with a 60-mm-long stapler cartridge and enterocolotomy was hand-sewn intracorporeally in two layers. Values were expressed as medians (ranges) for continuous variables.Results
There were 243 patients (143 females) aged 61 (range = 19–96) years, with body mass index of 29 (18–43) kg/m2 and ASA 1:2:3:4 of 52:110:77:4; 30 % had previous abdominal surgery and 38 % had a preexisting comorbidity. There were 84 ileocolic resections with ileo ascending anastomosis and 159 right colectomies with ileotransverse anastomosis. Operating time was 135 (60–220) min. Estimated blood loss was 50 (10–600) ml. Specimen extraction site incision length was 4.1 (3–4.4) cm. Conversion rate was 3 % and there was no mortality at 30 days, 15 complications (6.2 %), and 8 reoperations (3.3 %). Readmission rate was 8.7 %. Length of stay was 4 (2–32) days. Pathology confirmed Crohn’s disease in 84 patients, adenocarcinoma in 152, and other tumors in 7 patients.Conclusion
Laparoscopic intracorporeal ileocolic anastomosis following resection of the right colon resulted in a favorable outcome in selected patients with Crohn’s disease or tumors of the right colon. 相似文献2.
Ron Shapiro Uri Keler Lior Segev Stav Sarna Kamal Hatib David Hazzan 《Surgical endoscopy》2016,30(9):3823-3829
Background
Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses.Methods
This is a comparative study of two anastomosis techniques for laparoscopic right hemicolectomy. A total of 191 consecutive patients, operated for neoplasm of the right colon, were identified. The intracorporeal group included 91 patients and the extracorporeal group 100 patients.Results
Patient demographics and disease-related characteristics were similar. Mean operative time was longer in the intracorporeal group (155 vs. 142 min; P = 0.006). Intracorporeal anastomosis was associated with less overall postoperative complications (18.7 vs. 35 %, P = 0.011) and decreased rate of surgical site infections (4.4 vs. 14 %, P = 0.023). The need for postoperative intervention (Clavien–Dindo 3) was higher in the extracorporeal group (7 vs. 0 %; P = 0.015). There was no statistically significant difference in the incidence of postoperative leak, ileus and bleeding. Mean length of stay was significantly shorter in the intracorporeal group (5.9 ± 2.1 vs. 6.9 ± 3.0; P = 0.04). Moreover, more patients with intracorporeal anastomosis had a length of stay shorter than 4 days (28.6 vs. 14.1 %, P = 0.015). Extraction incision was periumbilical in 99 % of the patients in the extracorporeal group. In the intracorporeal group extraction, incision was transverse suprapubic (Pfannenstiel) in 85.7 %, transvaginal in 9.9 % and periumbilical in 3.3 % of the patients. The incidence rate of incisional hernia was lower in the intracorporeal group (2.2 vs. 17.0 %, P = 0.001).Conclusions
Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.3.
Background
Laparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols and laparoscopic surgery. Laparoscopic right hemicolectomy with an intracorporeal anastomosis (IA) is less invasive than laparoscopic assisted hemicolectomy, possibly leading to further decrease in post-operative morbidity and faster recovery. The current standard technique includes an extracorporeal anastomosis with mobilization of the colon, mesenteric traction and a extraction wound located in the mid/upper abdomen with relative more post-operative morbidity compared to extraction wounds located in the lower abdomen.Methods
A systematic review of PubMed and Embase databases was performed on studies comparing the intracorporeal versus the extracorporeal performed anastomosis in laparoscopic right hemicolectomy. Primary outcomes were mortality, short-term morbidity and length of stay. For quality assessment, the MINORS checklist was used. Meta-analysis was performed using a random-effects model, and a subgroup analysis was performed for data regarding short-term morbidity and length of stay in studies published in 2012≥.Results
A total of 2692 papers were identified, 12 non-randomized comparative studies were included in the analysis with a total number of 1492 patients. No significant change in mortality was found (OR 0.36, 95 % CI 0.09–1.46; I 2 = 0 %). Short-term morbidity decreased significantly in favour of IA (OR 0.68, 95 % CI 0.49–0.93; I 2 = 20 %). Length of stay was decreased, but with serious risk of heterogeneity (MD ?0.77 days, 95 % CI ?1.46 to ?0.07; I 2 = 81 %). Subgroup analysis for papers published in 2012≥ resulted in an even larger decrease in short-term morbidity (OR 0.65, 95 % CI 0.50–0.85; I 2 = 0 %) and a significant decrease in length of stay with low risk of heterogeneity (MD ?0.77 days, 95 % CI ?1.17 to ?0.37; I 2 = 4 %).Conclusion
Intracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay suggesting faster recovery as shown in this meta-analysis.4.
Minia Hellan Casandra Anderson Alessio Pigazzi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2009,13(3):312-317
Background:
During laparoscopic right hemicolectomy, the anastomosis can be created intra- or extracorporeally. This study aimed to determine whether a difference exists in short-term outcomes between these techniques.Methods:
Prospectively collected data of 80 consecutive patients who underwent laparoscopic right hemicolectomies since 2004 were reviewed retrospectively. An intracorporeal anastomosis was performed in 23 patients, an extracorporeal anastomosis in 57.Results:
There were no significant differences in median length of stay (4 days), number of removed lymph nodes, estimated blood loss, operative time (190 minutes intracorporeal vs. 180 minutes) and postoperative ileus (22% intracorporeal vs. 16%). The incision length was significantly shorter in the intracorporeal group (4cm vs. 5cm; P=0.004). Complications related to the anastomosis including twisting of the mesentery (n=2), anastomotic volvulus (n=1), or leak (n=1) occurred in 4 patients in the extracorporeal group compared with one minor anastomotic leak in the intracorporeal group. Major complication rates were similar between the 2 groups (4.3% intracorporeal vs. 5.3% extracorporeal).Conclusion:
The type of anastomosis does not influence short-term outcomes after laparoscopic right hemicolectomy. An intracorporeal anastomosis results in shorter incision length and may decrease wound-related complications. 相似文献5.
Ashley S. Vergis Sarah N. Steigerwald Faizal D. Bhojani Paul A. Sullivan Krista M. Hardy 《Canadian journal of surgery》2015,58(1):63-68
Background
There is wide variation among laparoscopic colon resection techniques, including the approach for mobilization and the extent of intracorporal vessel ligation, bowel division or anastamosis. We compared the short-term outcomes of laparoscopic right hemicolectomy (LRHC) with intracorporeal (IA) versus extracorporeal (EA) anastamosis.Methods
We retrospectively reviewed all elective laparoscopic right hemicolectomies performed at St. Joseph’s Hospital between January 2008 and September 2009 and compared the demographic, pathologic, operative and outcome data.Results
Fifty LRHCs were completed during the study period: 21 IA and 29 EA. The groups were similar in age, sex, body mass index, American Society of Anesthesiologists score, previous laparotomy and preoperative invasive pathology. There was no difference between IA and EA in mean duration of surgery (170 v. 181 min, p = 0.78), estimated blood loss (14 v. 42 mL, p = 0.15), perioperative blood transfusions (5% v. 14%, p = 0.29), in-hospital morbidity (33% v. 41%, p = 0.56), out-of-hospital morbidity (19% v. 31% p = 0.34), emergency department visits (10% v. 17%, p = 0.16) or 30-day readmissions (5% v. 7%, p = 0.75). There was 1 anastamotic leak in each group and no perioperative deaths. Median length of stay was significantly shorter for IA (4 v. 5 d, p = 0.05). There were 6 extraction site hernias with EA and none with IA (p = 0.026).Conclusion
Laparoscopic right hemicolectomy with IA has the advantage of a less hernia-prone Pfannenstiel extraction site, faster recovery and shorter stay in hospital EA. 相似文献6.
Jeonghyun Kang Im-kyung Kim Sung II Kang Seung-Kook Sohn Kang Young Lee 《Surgical endoscopy》2014,28(9):2747-2751
Background
Complete mesocolic excision (CME) has recently been reemphasized as a technical approach for anatomical dissection during colon cancer surgery. Although a laparoscopic approach for right colon cancer is performed frequently, identifying an adequate dissection plane is not always easy. In our practice, the patient lies in a modified lithotomy position. The first step is ileocolic area mobilization, followed by adequate retraction of the cecum laterally. This procedure enables discrimination of the ileocolic vessels and superior mesenteric vessels. Importantly, this method facilitates identification of the superior mesenteric vein (SMV), followed by the identification of the root of ileocolic pedicles. After that, sharp dissection along the SMV in an upward direction helps to safely identify the middle colic artery (MCA). Dissection then continues to the level of the origin of MCA, after which the right branch of MCA can be divided.Methods
A total of 128 consecutive patients (63 males) who underwent laparoscopic CME for right colon cancer by a single surgeon were analyzed in this study.Results
There was no conversion to open surgery. The median operation time was 192 min (interquartile range [IQR] 118–363 min). The median proximal and distal resection margins were 11 and 10 cm, respectively. The median number of harvested lymph nodes was 28 (IQR 3–88). There were six postoperative complications (4.6 %). The median hospital stay was 5 days (IQR 4–37 days). The video demonstrates a laparoscopic CME for a patient who had advanced distal ascending colon cancer.Conclusion
In conclusion, identifying the anatomical location of the SMV and performing meticulous dissection along the SMV is an essential procedure for containing all potential routes of metastatic tumors. Initial ileocecal mobilization with adequate counter traction of the cecum may be useful for novice surgeons attempting to identify the location of SMV during laparoscopic CME for right colon cancer. 相似文献7.
Carmelo Magistro Stefano Di Lernia Giovanni Ferrari Antonio Zullino Michele Mazzola Paolo De Martini Stefano De Carli Antonello Forgione Camillo Leonardo Bertoglio Raffaele Pugliese 《Surgical endoscopy》2013,27(7):2613-2618
Background
Several techniques are described in the literature about laparoscopic treatment of the right colon. Among them, laparoscopic-assisted colectomy (LAC) with creation of an extracorporeal ileocolonic anastomosis remains the favourite approach in most centers. So far, total laparoscopic colectomy (TLC) with intracorporeal anastomosis is not widely performed, because it requires adequate skills and competence in the use of mechanical linear staplers and laparoscopic manual sutures. The purpose of this study was to determine prospectively if TLC offers some advantages in short-term outcomes over LAC.Methods
A prospective comparative study was designed for 80 consecutive patients who were alternatively treated with TLC and LAC for right colon neoplasms. The following data were collected: operative time, intra- and postoperative complication rate, time to bowel movement, hospitalization time, length of minilaparotomy, number of harvested lymph nodes, and specimen length.Results
Operative time in TLC resulted significantly longer than in LAC (230 vs. 203 min), complication rate was similar in both groups, with no case of anastomotic dehiscence, two anastomotic bleedings in TLC vs. three in LAC and one case of postoperative ileus for each group. One case of death occurred in LAC patient developing a postoperative severe cardiopulmonary syndrome. Time to first flatus was in favour of TLC (2.2 vs. 2.6 days), whereas hospitalization was comparable. As regards to the oncological parameters of radicality, the specimen length was superior in TLC group, but the number of lymph nodes excised was equivalent. The length of the minilaparotomy was clearly shorter in TLC group (5.5 vs. 7.2 cm).Conclusions
No evidence of relevant differences in terms of functional and safety outcomes between the two laparoscopic procedures. TLC determines less abdominal manipulation and shorter incision length, but clear advantages must be still demonstrated. Larger series are necessary to test the superiority of totally laparoscopic procedures for right colectomy. 相似文献8.
Hiroki Akamatsu Takeshi Omori Tsukasa Oyama Masayuki Tori Shigeyuki Ueshima Masaaki Nakahara Takashi Abe Toshirou Nishida 《Surgical endoscopy》2009,23(11):2605-2609
Background
Current techniques of laparoscopic colectomy require an abdominal incision for extraction of the specimen. Although this incision is smaller than that for open laparotomy incision, it may reduce the advantages of laparoscopic surgery. In totally laparoscopic sigmoid colectomy, intracorporeal anastomosis is technically difficult. A safe and simple technique for circularly stapled intracorporeal anastomosis is described.Methods
After mobilization of the colon and division of the mesentery, a semicircumferential colotomy is made at the anterior colonic wall just proximal to the transection site. The anvil of a circular stapling device, secured with a Prolene suture, is introduced via the colotomy. The suture is advanced anteriorly so that the center rod of the circular stapling device penetrates the colonic wall. The colon is staple-transected at this point to secure the anvil on the proximal colon. A grasping forceps is brought through the rectum, and the specimen is extracted through the colotomy made at the distal staple line. After the colotomy is reclosed with a linear stapler, anastomosis is established using a hemidouble stapling technique.Results
Totally laparoscopic sigmoid colectomies were performed for 16 patients with colon cancers. All the patients were treated laparoscopically without any complications. The average operation time was 180 min. Although one patient experienced wound infection, no major complications occurred. There was no mortality in this series.Conclusions
The procedure of totally intracorporeal anastomosis combined with transanal extraction of the specimen can be performed easily, enabling surgeons to achieve minimal invasiveness comparable with that of hybrid natural orifice translumenal endoscopic surgery (NOTES). 相似文献9.
Comparisons between robotic and laparoscopic right hemicolectomy have been confounded by variations in operative technique. This study evaluates the two procedures after standardizing the intraoperative steps and perioperative management. Patients who underwent robotic right hemicolectomy with intracorporeal bowel anastomosis between July 2015 and June 2017 were matched with a laparoscopic group. Perioperative management was in accordance to an enhanced recovery protocol. Outcomes and histopathological data were compared. Thirty-two patients were included. Amongst the patients who did not undergo complete mesocolic excision, the median operative time did not differ between the two groups (p = 0.413). The robotic group recorded a statistically shorter time for intracorporeal anastomosis (13 vs 19 min, p = 0.024). Postoperative recovery and complication rates were similar, except for a greater lymph node harvest in the robotic group (41 vs 31, p = 0.038). Robotic surgery achieves short-term results comparable to existing conventional laparoscopy, notwithstanding the advantages of enhanced ergonomics. 相似文献
10.
S. G. Carpenter G. Grimsby T. DeMasters N. Katariya W. R. Hewitt A. A. Moss K. S. Reddy E. P. Castle D. C. Mulligan 《Journal of robotic surgery》2014,8(1):77-80
Background
Robotic surgery offers three-dimensional visualization and precision of movement that could be of great value to hepatobiliary surgeons. Previous reports of robotic choledochocele resections in adults have detailed extracorporeal jejunojejunostomies. We describe a total robotic excision of a choledochal cyst with hepaticojejunostomy and intracorporeal Roux-en-Y anastomosis.Methods
A 58-year-old woman underwent a robotic excision of a small choledochocele with hepaticojejunostomy and intracorporeal Roux-en-Y.Result
Port placement was determined via collaborative surgical discussion and previously reported robotic right hepatectomies. Total operative time was 386 min and total robot working time was 330 min. The hepaticojejunostomy was performed using 5-0 PDS suture with parachute-style back wall and running front wall sutures. The jejunojejunostomy was a stapled anastomosis. Estimated blood loss was less than 100 mL. The patient was ambulating and tolerating oral intake on post-operative day 1, and was discharged home on post-operative day 2.Conclusions
Robotic resection of choledochal cyst with intracorporeal Roux-en-Y anastomosis is feasible, with advantages over open surgery such as superior visualization, precision, and post-operative patient recovery. 相似文献11.
Background
The abdominal incision extraction site continues to be major source of morbidity after laparoscopic colectomy: mainly, incisional pain, wound infection, and incisional hernia. Also, in selected cases, it may delay initiating chemotherapy.Methods
The video describes the technique of performing laparoscopic total colectomy, transvaginal removal of the entire colon, and intracorporeal ileorectal anastomosis in a 40-year-old woman with a sigmoid cancer and multiple endoscopically unresectable polyps throughout the colon. Computed tomography scan showed 2 liver lesions with carcinoembryonic antigen 138. Familial adenomatous polyposis gene analysis was negative. Six trocars (one 12 mm and five 5 mm) were used. The whole colon was removed through the transvaginal route. The anvil was introduced through the vagina, and circular stapled ileorectal anastomosis was done.Results
There were no intraoperative complications. The operating time was 210 min. Blood loss was 20 mL. The patient was discharged home on postoperative day 2. Final pathology was T3N1bM1, and 2 of 23 lymph nodes were metastatic. All polyps were tubulovillous. She was commenced on chemotherapy 2 weeks after surgery. At 6-month follow-up, the patient was doing well, had no abdominal pain, and had no vaginal discharge or dyspareunia.Conclusions
Natural orifice specimen extraction (NOSE) surgery can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal incision–related morbidity and a bridge to pure natural orifice transluminal endoscopic surgery (NOTES) colon surgery. Large-number patient data with long-term follow-up is needed. 相似文献12.
Francesco Feroci Iacopo Giani Maddalena Baraghini Luca Romoli Tiku Zalla Roberto Quattromani Stefano Cantafio Marco Scatizzi 《Updates in surgery》2018,70(4):433-439
Our aim was to establish the safety and efficacy of barbed suture for enterotomy closure after laparoscopic right colectomy with intracorporeal anastomosis. This study included 47 patients who underwent laparoscopic right hemicolectomy with intracorporeal mechanical anastomosis and barbed suture enterotomy closure (barbed suture closure—BSC) for adenocarcinoma (with the exception of T4 lesions and metastasis), compared with 47 matched patients who underwent laparoscopic right hemicolectomy with intracorporeal mechanical anastomosis and conventional suture enterotomy closure (conventional suture closure—CSC) during the same period. Controls were matched for stage, age, and gender via a statistically generated selection of all laparoscopic right hemicolectomies performed from January 2009 until December 2015. There was no difference between the two groups in terms of age, sex, BMI, ASA, co-morbidity, previous abdominal surgery, cancer site and cancer staging. In terms of operating time (median 120 min for BSC and 127.5 min for CSC), histopathological results, surgical site complications (2.1% for BSC and 8.5% for CSC), hospitalization (median 6 days for BSC and 5 days for CSC), readmission rate (0%), there were no differences between the groups (p > 0.05). No significant differences were noted between the two groups in terms of the postoperative course. Our results support that the use of knotless barbed sutures for enterotomy closure after laparoscopic right colectomy with intracorporeal mechanical anastomosis is safe and reproducible. 相似文献
13.
Shingo Kanaji Hitoshi Harada Shunji Nakayama Takashi Yasuda Taro Oshikiri Kentaro Kawasaki Masashi Yamamoto Tatsuya Imanishi Tetsu Nakamura Satoshi Suzuki Kenichi Tanaka Yasuhiro Fujino Masahiro Tominaga Yoshihiro Kakeji 《Surgical endoscopy》2014,28(4):1250-1255
Background
Totally laparoscopic distal gastrectomy (TLDG) with intracorporeal anastomosis has been introduced to achieve safer anastomosis with good vision, and a small wound. However, little is known about the surgical outcomes of newly introduced TLDG compared with established procedures of laparoscopy-assisted gastrectomy (LADG) with extracorporeal anastomosis.Methods
This retrospective study included 114 patients who underwent laparoscopic distal gastrectomy (LDG) between January 2010 and September 2012. The patients were classified into two groups according to the approach of reconstruction (LADG group: n = 74; TLDG group: n = 40). The parameters analyzed included patients, operation details, and operative outcomes.Results
No complication was observed in the TLDG group. Surgical outcomes of the TLDG group, such as mean operation time, estimated blood loss, and rate of conversion to laparotomy were not inferior to the LADG group. Furthermore, postoperative hospital stay of the TLDG group was significantly shorter than the LADG group (p < 0.05).Conclusion
Surgical outcomes in the newly introduced phase of TLDG were safe as well as feasible compared with established LADG. TLDG has several advantages over LADG, such as shorter post-hospital stay, no incidence of operative complication, adequate working space, and small wound size. Although prospective, randomized control studies are warranted, we submit that TLDG can be used as a standard procedure for LDG. 相似文献14.
Ding-Pei Han Ai-Guo Lu Hao Feng Pu-Xiong-Zhi Wang Qi-Feng Cao Ya-Ping Zong Bo Feng Min-Hua Zheng 《Surgery today》2014,44(5):868-874
Purpose
To investigate the applicability, safety, short-term and long-term outcomes of laparoscopic surgery in the treatment of right-sided colon carcinomas with D3 lymphadenectomy.Methods
Between June 2003 and September 2010, 324 patients with right-sided colon carcinoma underwent surgical treatment in the same hospital, 177 cases were treated by laparoscopic surgery (LRH group) and 147 cases by open surgery (ORH group). We performed a retrospective analysis of the differences between the two groups in terms of the clinical data.Results
There were no significant differences between the two groups in the demographic data; however, the recovery time was significantly shorter in the LRH group, the number of overall lymph nodes harvested and principle lymph nodes harvested in the LRH group was significantly higher than in the ORH group, the incidence of postoperative complications was 12.99 % in the LRH group and 22.45 % in the ORH group (P < 0.05), and the recurrence rate in the LRH group was lower than that in the ORH group, although the difference was not significant (15.25 vs 19.73 %). The cumulative overall survival for all stages at 1, 3 and 5 years in the LRH group (97.18, 83.73 and 70.37 %) were not significantly different compared to those in the ORH group (94.56, 77.84 and 66.97 %).Conclusions
Laparoscopic-assisted right hemicolectomy with D3 lymphadenectomy for colon carcinomas is safe and effective, while it is also superior to open surgery regarding the short-term outcomes, and the long-term outcomes are similar to those of open surgery. 相似文献15.
Chaves JA Idoate CP Fons JB Oliver MB Rodríguez NP Delgado AB Lizoain JL 《Cirugía espa?ola》2011,(1):24-30
Introduction
There is still insufficient scientific evidence on which is the best technique to perform the anastomosis -intracorporeal (IC) or extracorporeal (EC)- in right laparoscopic hemicolectomy. The objective of the present study is to determine whether there are differences to compare in both techniques.Material and methods
A study was performed on a prospective patient series subjected to right laparoscopic hemicolectomy in our Hospital. The preoperative and the postoperative variables associated with complications recorded depending on the type of anastomosis.Results
A total of 60 patients were intervened form June 2004 to June 2010 (35 IC; 25 EC). There were no significant differences between both groups as regards baseline preoperative characteristics or associated comorbidities. The median operation time was 212 minutes (142-305 min), with no significant difference between both techniques. The number of lymph nodes removed was higher in the IC group (21 versus 14; p = 0.03). The beginning of oral tolerance and the first bowel movement were significantly earlier in the IC group. The complications rate was similar for both groups (14% IC; 16% EC; p = 0.89). Three patients in the IC group had anastomosis dehiscence. The mortality rate was 2.8% (one patient in each group).Conclusion
Intracorporeal versus extracorporeal anastomosis in right laparoscopic hemicolectomy can obtain a higher number of resected lymph nodes and an earlier oral tolerance and intestinal transit. 相似文献16.
Omar H. Llaguna 《American journal of surgery》2010,200(2):265-269
Background
There are few studies that compare the incidence of incisional hernia following elective laparoscopic colon resection to open colectomy and determine the risk factors for its development.Methods
Elective open and laparoscopic colon resections performed between February 2002 and May 2007 were reviewed. In the laparoscopic group, mesenteric transection was performed via intracorporeal division for left-sided colectomy and via extracorporeal technique for right-sided colectomy. The ileocolic anastomosis was performed by extracorporeal stapling for right colectomies and by intracorporeal for left colectomies.Results
Two hundred eighteen patients (mean age 62 years, 52% male) underwent elective colon resection (50% open, 5% hand-assisted, and 45% laparoscopic). Six percent of the cases that started as laparoscopic were converted and are included in the open group. Mean follow-up was 26 months. The overall incisional hernia rate was 16% (open and minimally invasive group 17% vs 15%, P = .14). Hernia was not dependent on the type of resection, indication, or extraction site. Body mass index >36 kg/m2, male gender, and surgical site infection were risk factors for hernia development.Conclusions
Laparoscopic colectomy does not reduce the development of incisional hernia. 相似文献17.
Brown SR Meyers J Jenkins ED Frisella MM Brunt LM Eagon JC Davis KG Matthews BD 《American journal of surgery》2010,200(6):851-855
Background
The purpose of this study was to compare perioperative outcomes for intracorporeal versus extracorporeal anastomotic techniques for isolated laparoscopic small-intestine resection.Methods
A retrospective database was created for all adult patients who underwent a laparoscopic segmental small-intestine resection. Patients with inflammatory bowel disease or requiring an ileocolectomy were excluded.Results
Laparoscopic resection was performed in 52 patients (ratio of men:women, 30:22) with a mean age of 47 ± 21 years. A laparoscopic intracorporeal anastomosis was performed in 30 patients (58%), and an extracorporeal anastomosis was performed in 22 patients (42%). There was no difference in mean operating room time, estimated blood loss, perioperative complication rate, or length of stay between the 2 groups. Ten patients had a complication, and 5 patients experienced a Clavien grade II or greater complication.Conclusions
Laparoscopic segmental small-bowel resection using either intracorporeal or extracorporeal anastomotic techniques is equally efficacious for pathology isolated to the small bowel. 相似文献18.
Vassiliki L. Tsikitis Stefan D. Holubar Eric J. Dozois Robert R. Cima John H. Pemberton David W. Larson 《Surgical endoscopy》2010,24(8):1911-1916
Background
Fast-track (FT) recovery protocols have demonstrated advantages over historical recovery routines after open colectomy; however, their impact in recovery after laparoscopic colectomy is not clearly defined. This study was designed to determine whether patients who recover on FT protocol after laparoscopic colectomy have a shorter length of stay (LOS) and fewer complications compared with patients who recover on standard (non-FT) protocol.Methods
A cohort of consecutive patients with colon cancer who underwent completed laparoscopic-assisted right hemicolectomy from 2005–2007 was identified. Univariate and multivariate logistic analyses were performed to identify risk factors for increased LOS and postoperative complications with recovery protocol as the primary predictor.Results
A total of 197 patients were included: 115 (58%) patients recovered on a non-FT protocol, and 82 (42%) patients on FT protocol. Univariate analysis showed no differences with respect to age, gender, body mass index, or American Society of Anesthesiologists (ASA) class between groups. The median (interquartile range) LOS was 4 (range, 3–6) days and 3 (range, 3–4) days for the non-FT and FT recovery patients, respectively (p < 0.001). On multivariate analysis, independent risk factors for increased LOS were complications (p < 0.001) and non-FT recovery (p = 0.007). Non-FT recovery also was associated with increased complications (56 vs. 29%, p = 0.0002); this remained significant on multivariate analysis (p < 0.001). Readmissions were similar (p = 1.0) between recovery groups. No mortalities were observed at 30 days.Conclusions
Fast-track recovery is independently associated with a shorter LOS and decreased morbidity after laparoscopic right hemicolectomy. 相似文献19.
Deok Gie Kim Yoon Young Choi Ji Yeong An In Gyu Kwon In Cho Yoo Min Kim Jung Min Bae Myung Gyu Song Sung Hoon Noh 《Surgical endoscopy》2013,27(9):3153-3161
Background
Since delta-shaped gastroduodenostomy was introduced, many surgeons have utilized laparoscopic distal gastrectomy (LDG) with totally intracorporeal Billroth I (ICBI) for gastric cancer, because it is expected to have several advantages over laparoscopic-assisted distal gastrectomy with extracorporeal Billroth I (ECBI). In this study, we compared these two reconstruction options to evaluate their outcomes.Methods
The data of 166 gastric cancer patients who underwent LDG performed by a single surgeon between April 2009 and February 2012 were analyzed retrospectively. The subjects were divided into ECBI (n = 106) and ICBI (n = 60) groups, and then the clinical characteristics, surgical outcomes, symptoms, and change in BMI at 3 months after surgery were compared. Furthermore, a rapid systematic review and meta-analysis were conducted.Results
The operative time was significantly shorter in the ICBI group (197.4 ± 45.5 vs. 157.1 ± 43.9 min), but blood loss was similar between the groups. Regarding surgical outcomes, there were no significant differences in the length of hospital stay, soft diet initiation, visual analogue scale, frequency of analgesics injection, and postoperative white blood cell counts and C-reactive protein levels between the groups. The surgical complication rates were 5.7 and 13.3 % in the ECBI and ICBI groups, respectively, and one case of anastomosis leakage was observed in each group. At 3 months after surgery, reflux symptoms were more frequent in the ICBI group, but other gastrointestinal symptoms and the change of BMI were similar between the groups. The meta-analysis revealed no significant differences in the operative time, time to first flatus, length of hospital stay, frequency of analgesic usages, and rates of anastomosis complications between the groups.Conclusions
We could not demonstrate the clinical superiority of ICBI over ECBI based on our data and a rapid systematic review and meta-analysis. The anastomosis method may be selected according to patient conditions and the surgeon’s preference. 相似文献20.
Ji-Hun Kim In-Kyu Lee Won-kyung Kang Seung-Teak Oh Jun-Gi Kim Yoon-Suk Lee 《Surgical endoscopy》2013,27(8):2900-2906