手辅助腹腔镜结直肠癌术后切口疝的发生危险因素分析

目的:探讨手辅助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌术后切口疝发生的相关危险因素,为预防术后切口疝的发生提供证据。方法:回顾分析2009年8月至2012年8月为142例患者行HALS结直肠癌切除术的临床资料,至随访结束时,根据手辅助口位置是否发生切口疝将患者分为切口疝组及无切口疝组,分析两组患者年龄、性别、体质指数(body mass index,BMI)、吸烟、伴随疾病、辅助切口位置、切口长度、是否感染等与切口疝发生相关的危险因素。结果:入选的142例患者中,13例至随访结束时发生切口疝,发生率为9.2%,合并糖尿病的患者术后切口疝发生率明显高于无糖尿病患者(P<0.01),切口疝组患者平均BMI、吸烟率亦高于无切口疝组,与左下腹低位横切口相比,正中切口术后疝的发生率较高。结论:肥胖、吸烟、糖尿病、切口位置与切口疝的发生密切相关,充分的围手术期准备,可有效减少切口疝的发生。     

Hand-assisted laparoscopic aortobifemoral bypass for occlusive disease. Early and mid-term results.

OBJECTIVES: To evaluate the early and mid-term results of hand-assisted laparoscopic surgery (HALS) for aorto-iliac reconstruction. DESIGN: Prospective survey. MATERIALS AND METHODS: Between February 2002 and January 2004, 46 patients received an aortobifemoral bypass for advanced occlusive disease by HALS. RESULT: There was one conversion to open surgery. Mortality was 4.5%. The median return to solid oral diet took 36 h (24-182), the median hospital stay was 5 days (3-26). Primary patency rate at 1 year was 97.5%. The incidence of incisional hernia was 19.5%. CONCLUSIONS: HALS aorto-iliac reconstruction should be considered as a minimal invasive technique with good early and mid-term results.     

手助腹腔镜全结肠切除术治疗结肠无力症的临床研究

目的比较手助腹腔镜与开腹全结肠切除术的临床疗效,评价手助腹腔镜全结肠切除术在结肠无力症手术治疗中的应用价值。方法采用前瞻性随机对照研究的方法,将2001年1月至2006年6月收治的42例结肠无力症患者分为传统开腹手术（22例）和手助腹腔镜手术（20例）两组,比较两组患者的一般临床资料、手术情况（手术时间、出血量、切口长度）、术后情况（肛门排气时间、进流质时间、术后平均住院日、术后早期并发症以及费用）,并随访术后排便情况。结果开腹组与手助腹腔镜组一般临床资料无明显差别。42例均行全结肠切除术,无手术死亡。两组的手术时间、术中出血无明显差别;但两组的手术切口长度、术后肛门排气时间、进流质时间和术后平均住院天数差异有统计学意义（P〈0．05）,手助腹腔镜组优于传统开腹手术组;但平均住院费用手助腹腔镜组高于开腹组（P〈0．05）。开腹组1例发生切口感染,1例出现早期肠梗阻。手助腹腔镜组术后无明显并发症。术后随访2～14个月,两组平均排便（3．55±1．80）次／d。结论手助腹腔镜与开腹全结肠切除术均安全、简捷、有效,前者更有手术外观好、术后恢复快的优点。     

Incisional hernia following hand-assisted laparoscopic surgery for renal cell cancer.

OBJECTIVES: For renal cell cancer, the hand-assisted laparoscopic approach provides several advantages while maintaining equal advantages with regards to patient recovery. We offer our experience with laparoscopic hand-assisted radical nephrectomy and the incidence of ventral wall hernia. METHODS: Between February 1999 and July 2002, we performed 50 laparoscopic hand-assisted radical nephrectomies. A midline or a muscle splitting right lower quadrant incision was used depending on the side of the tumor. Hand-port incisions were all between 7 cm and 8 cm and closed with #1 polydioxanone sulfate suture in a running fashion. Three (6%) patients developed hand-port incisional hernias. All hernias occurred in midline hand-port sites. The average body weight of those who developed an incisional hernia was 137 kg. Although the cause of incisional hernia is multifactorial, we believe that obesity plays a significant role. The technical limitations involved in closing a short, deep ventral incision combined with the earlier return to activity of laparoscopy patients put this patient population at significant risk. CONCLUSION: We now perform an interrupted closure with nonabsorbable suture for the hand-assist incision and limited activity for 4 weeks to 6 weeks post procedure in high-risk patients. We have had no further wound hernias since adopting these changes.     

Wound complications after hand assisted laparoscopic surgery

PURPOSE: Hand assisted laparoscopic surgery (HALS) provides benefits similar to standard laparoscopy but generally requires a larger incision. We assessed the nature of and risk factors for incisional complications after HALS. MATERIALS AND METHODS: All patients who underwent HALS at our institution from February 1997 through December 2003 were included in a prospective and retrospective review to assess postoperative wound complications. Literature regarding wound complications associated with open surgery and standard laparoscopy was reviewed. RESULTS: A total of 424 consecutive procedures performed on 422 patients were evaluated. Postoperative HALS incision site complications included 29 infections (6.8%), 15 hernias (3.5%) and 2 dehiscences (0.5%). Multivariate logistic regression models revealed that HALS incision site hernias were associated with current or past tobacco smoking (6.0%, p = 0.04), with a trend toward significance for diabetes mellitus (14%, p = 0.07), male gender (5.3%, p = 0.08) and renal failure (16%, p = 0.08). HALS incision site infections were associated with omission of perioperative antibiotics (13%, p = 0.007), obesity (12%, p = 0.03) and increased operative time (252 vs 222 minutes in patients with and without infection, respectively, p = 0.001). CONCLUSIONS: Our findings suggest that wound infections and hernias occur less frequently with HALS than with open surgery, but more often than with standard laparoscopy. Certain patient comorbidities (eg obesity), modifiable risk factors (eg smoking status) and procedural variables (eg omission of perioperative antibiotics or length of procedure) may adversely influence HALS wound complications. This information can be used to decide between HALS and standard laparoscopic approaches in particular patients.     

手助腹腔镜与腹腔镜辅助全直肠系膜切除的近期临床效果对比

目的探讨手助腹腔镜（HALS）直肠癌全直肠系膜切除（TME）根治术的临床效果。方法选择沈阳军区总医院普通外科2010年1月至2011年3月期间住院手术的42例直肠癌患者,分别采用HALS（HALS组,19例）和腹腔镜辅助（腹腔镜辅助组。23例）进行TME直肠癌根治手术,并对两组患者的临床效果进行对比分析。结果两组患者手术均顺利完成。手术切缘均为阴性。HALS组和腹腔镜辅助组手术时间分别为（152±17）min和（168±19）min（t=2．767,P=0．009）;Dixon手术切口长度分别为中位数5．6em和4．512cm（P=0．000）;住院费用分别为2．6万元和2．9万元（P=0．008）：而术中失血量、清除淋巴结数、术后排气时间和住院时间两组差异无统计学意义（均P〉0．05）。结论HALS直肠癌TME根治术同样具备腹腔镜辅助手术微创、安全、术后恢复快和创伤小的优点。     

Does nasogastric tube decompression get used less often with laparoscopic and hand-assisted compared with open colectomy?

Introduction

Laparoscopic surgery is associated with well-known benefits, one of which is earlier return of bowel function. Since the laparoscopic approach to colon resections was introduced in the early 1990s, it has become the standard of care. Hand-assisted laparoscopic surgery (HALS) is a surgical approach in which dissection is facilitated by the surgeon’s hand within the abdominal cavity during laparoscopy. The purpose of this study was to compare the incidence of postoperative ileus and the need for nasogastric tube (NGT) decompression in patients undergoing elective colon resections.

Methods and procedures

Following institutional review board approval, we performed a retrospective review of a prospectively collected database. Included were patients who underwent elective left-sided large bowel resections between 2009 and 2012. Exclusion criteria were urgent operation, stoma creation, ASA IV classification, NGT left in place at the end of surgery, and postoperative anastomotic leakage. Patients were divided into three groups: laparoscopic surgery, HALS, and open surgery. We evaluated the incidence of postoperative ileus and the use of nasogastric decompression in each group.

Results

A total of 243 patients were included in this study; 73 patients underwent open surgery, 89 patients underwent HALS, and 81 patients underwent laparoscopic surgery. The proportion of patients who needed postoperative nasogastric decompression was significantly reduced in patients undergoing laparoscopic surgery (3.7 %) or HALS (4.5 %) compared with those who underwent open resection (17.8 %). The time from surgery to first flatus and first bowel movement, the time to tolerate solid diet, and the total length of postoperative hospital stay also were all significantly reduced in the laparoscopic and HALS groups compared with the open surgery group. There were no significant differences in any of these measures between the laparoscopic group and the hand-assisted group.

Conclusions

Like laparoscopy, HALS is associated with less postoperative ileus and necessitates less NGT decompression than does open surgery.     

手助腹腔镜外科技术在腹部外科中的应用(附113例报告)

目的:探讨手助腹腔镜外科(hand-assisted laparoscopic surgery,HALS)技术在复杂外科手术中的应用价值。方法:2002年2月至2006年12月应用HALS技术治疗113例患者,对临床相关指标,如手术时间、术中出血量、术后并发症等进行观察和分析。结果:113例患者中,110例获得成功,术后并发症发生率为5.45%,无死亡病例。结论:HALS技术可提高复杂腹腔镜手术的效率和安全性,并在一定程度上保留了微创手术创伤小、康复快的优势。     

Laparoscopic versus open incisional hernia repair

BACKGROUND: To analyze hospital resource utilization for laparoscopic vs open incisional hernia repair including the postoperative period. METHODS: Prospectively collected administrative data for incisional hernia repairs were examined. A total of 884 incisional hernia repairs were examined for trends in type of approach over time. Starting October 2001, detailed records were available, and examined for operating room (OR) time, cost data, length of stay (LOS), and 30-day postoperative hospital encounters. RESULTS: Of the total, 469 incisional hernias were approached laparoscopically (53%) and 415 open (47%). Laparoscopic repair had shorter LOS (1 +/- 0.2 days vs 2 +/- 0.6 days), longer OR time (149 +/- 4 min vs 89 +/- 4 min), higher supply costs (2,237 dollars +/- 71 dollars vs 664 dollars +/- 113 dollars), slightly lower total hospital cost (6,396 dollars +/- 477 dollars vs 7,197 dollars +/- 1,819 dollars), and slightly more postoperative hospital encounters (15% vs 13%). Use of laparoscopy increased over time (37% in 2000 vs 68% in 2004). CONCLUSIONS: Laparoscopic incisional hernia repair is becoming increasingly popular, and not at increased cost to the health care system.     

Incidence of incisional hernias in patients operated on for aneurysm or occlusive disease

The purpose of this study was to evaluate the incidence of postoperative incisional hernias after elective open abdominal aortic aneurysm (AAA) repair versus aortofemoral reconstruction. In this open prospective study, 281 patients who underwent elective open AAA or aortofemoral repair were included. All patients were evaluated by clinical examination 1 month after the operation, every 6 months for the next 5 years, and every year thereafter for the presence of an incisional hernia. Mean duration of follow-up was 63.7 months (range, 12-144 months). Seventeen patients (6.2%) were lost to follow-up. The development of a postoperative incisional hernia was recorded and analyzed with regard to the demographic data and the traditional risk factors for atherosclerosis. Statistical analysis was performed using the Kaplan-Meier method and the Cox regression analysis. The development of a postoperative incisional hernia after AAA surgical repair had an incidence of 16.2 per cent versus 7.4 per cent after aortofemoral reconstruction. Patients electively operated on for AAA have a 3.8-fold increase of developing a postoperative incisional hernia over patients operated on for peripheral occlusive disease (POD).     

High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection

Background

The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after laparoscopic colectomy.

Methods

Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009 were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire. Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups.

Results

Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4?years, p?=?0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications and extraction site. Mean length of follow-up was 37.0?months. The overall incidence of incisional hernia was 21% (21/99), being 29?% (20/68) after midline incision compared with 14?% (1/7) after transverse and 0?% (0/24) after Pfannenstiel incisions (p?=?0.002). Of patients with incisional hernia, 47?% (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic score (14.4 vs 17.7, p?=?0.02) compared with those without, but there was no difference in body image score. There were no differences in body image or cosmesis between the three incisions.

Conclusions

There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen extraction.     

Comparison of laparoscopic versus hand-assisted live donor nephrectomy

BACKGROUND: The aim of the present study was to compare hand-assisted laparoscopic live donor nephrectomy with the classic laparoscopic method, using meta-analytical techniques. METHODS: A literature search was performed for studies comparing hand-assisted laparoscopic nephrectomy with classic laparoscopic nephrectomy for live kidney donation between 1999 and 2005. The following end points were evaluated: operative time, warm ischemia time, intraoperative adverse events, donor and recipient postoperative complications, and length of hospital stay. RESULTS: Nine comparative studies matched the selection criteria, reporting on 376 patients, of whom 202 (53.7%) had hand-assisted laparoscopic nephrectomy and 174 (46.3%) had the classic laparoscopic technique. Conversion to open surgery was 2.97% in the hand-assisted group and 4.60% in the laparoscopic group (P=0.35). Total operative and warm ischemia times were significantly shorter for hand-assisted laparoscopy by 30.03 minutes (P=0.02) and 1.14 minutes (P<0.001), respectively. The intraoperative blood loss was less for the hand-assisted laparoscopy group by 34.16 mL (P=0.008), although intraoperative (3.46% vs. 7.47%; P=0.24) and postoperative (5.94% vs. 10.34%; P=0.30) donor complications and recipient complications (including delayed graft function and primary nonfunction, 8.41% vs. 7.42%; P=0.32) were similar between the hand-assisted and laparoscopic groups. CONCLUSION: Hand-assisted laparoscopic nephrectomy appeared to have the same donor and recipient complication rate with standard laparoscopy but offered substantial advantages in terms of shortened operative and warm ischemia time as well as decreased intraoperative bleeding.     

Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication?

We evaluated the true incidence of seroma formation after laparoscopic repair of incisional hernia with polytetrafluoroethylene (PTFE) patch. In a prospective study, 20 patients who underwent laparoscopic repair of incisional hernia with PTFE were evaluated clinically and with ultrasound examination for seroma formation up to the 90th postoperative day. Seroma was diagnosed clinically in only 35% of cases, while ultrasound examination revealed the presence of seroma in 100% of patients. Ultrasound examination is a reliable tool for diagnosis of early or delayed postoperative seroma formation following laparoscopic repair of incisional hernia with Gore-Tex Dualmesh. Electronic Publication     

Hand-assisted laparoscopic low anterior resection

Background: Laparoscopic low anterior resection for rectal cancer has never gained wide acceptance among general surgeons, mainly due to the technical difficulties encountered during pelvic dissection. It has therefore been stated that these patients should undergo open rather than laparoscopic surgery. Hand-assisted laparoscopic surgery (HALS) is a new technique that has the potential to overcome many of the existing limitations of pure laparoscopy. In the treatment of rectal cancer, HALS could reproduce an operative setting similar to that of the open approach. Methods: To assess the technical feasibility of hand-assisted laparoscopic low anterior resection for rectal cancer and evaluate potential benefits and drawbacks of this new procedure, a pilot study was conducted at a university hospital on 16 consecutive patients during a 12-month period. Only patients with extraperitoneal rectal cancer were included in this series. Patients' clinical data, operative time, conversion rate, complications, and early outcome measures were prospectively examined. Results: There were 9 men and 7 women. The average ± SD operation time was 238 ± 38 min. Conversion to open surgery was never required. Ten of 16 patients were off pain medication on the third postoperative day. Eight were able to walk the day after surgery. Three minor postoperative complications were recorded. Mean postoperative stay for patients without complications was 5.6 ± 1.4 days. Conclusion: From a technical standpoint, the reported hand-assisted procedure makes pelvic dissection during laparoscopic low anterior resection almost equivalent to the laparotomic operation. The incision for hand access that is needed with this technique does not seem to compromise the quick recovery of patients undergoing purely laparoscopic procedures.     

Evolution of minimally invasive bariatric surgery

BACKGROUND: Minimally invasive Roux-en-Y gastric bypass is a procedure that is being performed with increasing frequency. It is an advanced laparoscopic procedure with a steep learning curve. With experience, it can be performed in a reasonable amount of time with minimal morbidity. METHODS: We first performed minimally invasive gastric bypass with the hand-assisted laparoscopic surgery (HALS) technique. After significant experience with HALS, we changed our approach to completely laparoscopic (LS). Our technique for all cases involves a circular stapled gastrojejunostomy with a 25-mm anvil passed transgastrically. RESULTS: From June 1998 to January 2002, 304 patients underwent minimally invasive gastric bypass. Our first 81 cases were with HALS, and the rest were LS. The incidence of early major and minor perioperative complications for the entire series was 5.6% and 7.9%, respectively. Early reoperation (less than 30 days) was required in 4.6% of all patients. There was 1 leak (1.2%) in the HALS group and 4 anastomotic leaks (1.8%) in the LS group. Other measured outcomes were similar in each group with the exception of wound hernia (16% HALS vs 0.9% LS). Weight loss after 1 year was 44% for HALS and 56% for LS. We have not had any deaths in our series. CONCLUSIONS: HALS may have certain advantages in selected patients and early in a surgeon's experience with minimally invasive gastric bypass. With experience, good results are possible with either approach.     

Laparoscopic ventral incisional hernia repair: A more effective alternative to conventional repair of recurrent incisional hernia

Conventional repair of recurrent ventral incisional hernia is associated with a higher recurrence rate (30%-50%) than repair of primary incisional hernia (11%-20%). Laparoscopic incisional hernia repair (LIHR) can significantly reduce the recurrence rate of primary hernia to less than 5%. In this study, we evaluate the efficacy of repairing recurrent incisional hernia laparoscopically. One-hundred and seventy consecutive patients undergoing LIHR between January 1995 and December 2002 were prospectively reviewed. Patients with recurrent incisional hernia (n = 69) were compared to patients with primary incisional hernia (n = 101). Patient demographics and perioperative and postoperative data were recorded prospectively. Follow-up was obtained from office visits and telephone interviews. Statistical analysis was performed using the Student t test and the x ²test. Results are expressed as means ± standard deviation. The patients with recurrent incisional hernia had a mean of 1.9 ± 1.3 previous repairs, higher body mass index (BMI) (34 ± 6 kg/m² vs. 33 ± 8 kg/m², P = 0.46), larger defect size (123 ± 115 cm² vs. 101 ± 108 cm², P = 0.06), and longer operative time (119 ± 61 minutes vs. 109 ± 44 minutes, P= 0.11). The complication rate was higher in the recurrent group (28% vs. 11%, P = 0.01), but the recurrence rate was not different (7% vs. 5%, P= 0.53). The mean time to recurrence was significantly shorter in the recurrent group (3 ± 2 months vs. 14 ± 7 months, P < 0.0001). The mean follow-up interval was 19 ± 18 months in the recurrent group and 27 ± 20 months in the primary group. Although laparoscopic repair of recurrent incisional hernia resulted in a higher recurrence and complication rate than laparoscopic repair of primary incisional hernia, the rates were lower than those reported for conventional repair of recurrent incisional hernia. Laparoscopic repair of recurrent incisional hernia is an effective alternative to conventional repair. Supported in part by Tyco/US Surgical Corporation through an educational grant to the University of Kentucky Center for Minimally Invasive Surgery.     

Hand-assisted Laparoscopy Versus Conventional Median Laparotomy for Aortobifemoral Bypass for Severe Aorto-iliac Occlusive Disease: A Prospective Randomised Study

OBJECTIVES: To demonstrate that hand-assisted laparoscopy for aortofemoral bypass for severe aorto-iliac occlusive disease reduces morbidity with earlier recovery of bowel function and shorter in-hospital stay. DESIGN: Randomised controlled trial. MATERIALS AND METHODS: Thirty-six consecutive patients with severe aorto-iliac occlusive disease (TASK C/D) without history of major abdominal surgery necessitating an aortobifemoral bypass were randomised between a hand-assisted laparoscopic (HALS) approach and a conventional medial laparotomy. Operative data, early recovery data, quality of life and vascular outcome were analysed. RESULTS: No significant differences in operative data were found. Fluid and solid diet were resumed earlier (28.8 hrs vs. 76.9 hrs; p = 0.016) (45.6 hrs vs. 105.6 hrs; p = 0.02) and in-hospital stay was shorter (7.5 vs. 8.9 days; p = 0.005) in the HALS group. Six weeks post-operatively social functioning measured by the SF-36 survey score was better in patients randomised to HALS (p=0.023). CONCLUSIONS: HALS is a less invasive approach for aortofemoral bypass.     

腹腔镜手助与辅助技术在右半结肠切除术中应用的对比研究

目的 比较腹腔镜手助与辅助技术在右半结肠癌根治术中的应用效果.方法 回顾性分析北京协和医院基本外科同一组医师2002年3月至2006年11月采用腹腔镜手助技术(HALS组,47例)和2007年1月至2009年12月采用腹腔镜辅助技术(LAS组,48例)完成的右半结肠癌根治术患者的临床资料.对比其手术安全性、术后恢复情况和并发症、肿瘤根治性、医疗费用和随访结果.结果 HALS组和LAS组术中、术后均无严重并发症和死亡病例.HALS组与LAS组相比,术中出血(P<0.01)、手术时间(P<0.05)和切口长度(P<0.05)差异均有统计学意义;但中转开腹、术中副损伤术后肛门排气时间、下床时间、住院天数、进食时间、术后镇痛例数方面的差异均无统计学意义(均P>0.05).HALS组手术切除标本长度为(25.6±9.9)cm,与LAS组的(26.8±7.9)cm比较,差异无统计学意义(P>0.05):HALS组淋巴结清扫总数为(18.2±12.1)枚,与LAS组的(24.1±9.3)枚比较,差异有统计学意义(P<0.05).LAS组的医疗费用(28 049.8±7576.1)元,多于HAKS组的(21 132.7±5323.4)元(P<0.05).HALS组和LAS组3年生存率分别为91.3%和87.9%,差异无统计学意义(P=0.452).结论 腹腔镜手助和辅助技术在右半结肠切除术中可获得相同的微创效果和肿瘤学疗效.

Abstract：

Objective To compare the outcomes of right hemicolectomy performed either by the hand-assisted laparoscopic (HALS) or conventional laparoscopic surgery (LAS). Methods Ninety-five patients undergoing HALS(n=47) from March 2002 to November 2006 or by LAS (n=48) from January 2007 to December 2009 were retrospectively studied. All the operations were performed by the same surgical team. Patient safety, postoperative recovery, complications, oncologic outcomes, medical expenses, and the follow-up results were compared between the two groups. Results No severe complications or perioperative deaths were oberved. There were significant differences between the two groups in terms of intraoperative bleeding, operative time, and length of incision (all P<0.05). However, the conversion rate, intraoperative injuries, time to first bowel movement, postoperative bedrest time, hospital stay, time to first oral intake, and the number of patients requiring postoperative analgesia were comparable between the two groups (P>0.05). Length of surgical specimen was (25.6±9.9) cm in the HALS group and was (26.8±7.9) cm in the LAS group, the diffenence was not statistically significant (P<0.05).The mean number of lymph nodes retrieved in HALS group was 18.2± 12.1, which was significantly lower than that in LAS group (24.1 ±9.3, P<0.05). The medical expense of the LAS group was (28 049.8±7576.1) RMB, which was significantly higher than that of the HALS group (21 132.7±5323.4) RMB (P<0.05). A follow-up rate of 93.7% was achieved in the HALS group with 3 patients lost to follow-up. The follow-up duration ranged from 45.4 to 101.9 months with a median of 66.7 months. In LAS group, the follow-up rate was 96% with 2 patients lost to follow-up and the follow-up duration ranged from 12.4 to 45.7 months with a median of 21.6 months. There was no significant difference in 3-year disease-free survival (91.3% vs. 87.9%, P> 0.05) between the two groups. Conclusion HALS and LAS can achieve similar minimal invasiveness efficacy and oncologic outcomes for right hemicolectomy.     

Laparoscopic incisional hernia repair after colorectal surgery. Is it possible to maintain a mini-invasive approach?

Several benefits have been described in laparoscopic surgery. However, there is a lack of evidence concerning laparoscopic repair of incisional hernia after laparoscopic colorectal surgery (LCRS). We aimed to evaluate the feasibility and the results of laparoscopic incisional hernia repair after LCRS. Between May 2001 and March 2014, all charts of consecutive patients who underwent LCRS and developed an incisional hernia were evaluated. Patients with parastomal hernias or those with less than 6 months of follow-up were excluded. Patients were assigned to laparoscopic repair group (LR) and open repair group (OR). Demographics, surgical factors, and 30-day postoperative complications were analyzed. The incisional ventral hernia rate was 7 % (90/1290), and 82 incisional hernia repairs were performed. In 49 patients (60 %) an open approach was performed, and there were 33 laparoscopic repairs (2 converted due to small bowel injury). Mean age was 62 years. Average body mass index was 27.4 ± 5.2 kg/m². The mean defect size was 56 (4–527) cm², and there were no differences between the groups (LR: 49 cm² vs OR: 63 cm²; p = NS). Average operative time was 107 (45–240) minutes (LR: 93 min vs OR: 116 min, p = 0.02). OR showed a higher rate of postoperative complications (OR: 51 % vs LR: 18 %, p = 0.003) and increased hospital stay (OR: 2.77 ± 4 days vs LR: 0.7 ± 0.4 days; p = 0.02). The recurrence rate was 15 % (12 patients, 6 each group; p = NS) after a follow-up of 48 (r: 6–141) months. Laparoscopic approach for incisional hernia repair after LCRS seems to be safe and feasible. Patients who received laparoscopic approach showed significantly less postoperative complications and shorter hospital staying. These observations suggest that mini-invasive surgery may be the initial approach in patients who develop an incisional hernia after LCRS.     

Laparoscopic ePTFE mesh repair of incisional and ventral hernias

Incisional hernia is a relatively frequent complication of abdominal surgery. The use of mesh to repair incisional and ventral hernias results in lower recurrence rates compared with primary suture techniques. The laparoscopic approach may be associated with lower postoperative morbidity compared with open procedures. Long-term recurrence rates after laparoscopic ventral and incisional hernias are not well defined. A prospective study of the initial experience of a standardized technique of laparoscopic incisional and ventral hernia repair carried out in a tertiary referral hospital was undertaken between January 2003 and February 2007. Laparoscopic hernia repair was attempted in 71 patients and was successful in 68 (conversion rate 4%). The mean age of the patients identified was 63.1 years (39 men and 31 women). Multiple hernial defects were identified in 38 patients (56%), and the mean overall size of the fascial defects was 166 cm(2). The mean mesh size used was 403 cm(2). The mean operative time was 121 minutes. There were six (9%) major complications in this series, but there were no deaths. Hernia recurrence was noted in four patients (6%) at a mean follow up of 20 months. Our preliminary experience indicates that laparoscopic incisional and ventral hernia repair is technically feasible and has acceptable postoperative morbidity and low early recurrence rates.