Laparoscopic assisted colectomy: experience from a rural centre

Abstract

Background: This study presents an audit of the first 50 elective laparoscopic assisted colorectal resections carried out at the Launceston General Hospital, Tasmania, particularly in comparison with the 33 elective open resections carried out in the same 18-month period.

Methods: This was a retrospective review and analysis of prospectively recorded data on an intention-to-treat basis using non-parametric methods.

Results: With respect to case selection, patients in the laparoscopic group were younger (median = 63 years (range 19-98 years) vs 69 years (33-93 years), P = 0.0392) and more patients had benign pathology (22/50, 44% vs 4/33, 12%, P = 0.002). There was no significant difference in sex or American Society of Anesthesiologists status (P = 0.499 and 0.517, respectively). There were more left-sided than right-sided resections (28/50, 56% vs 14/33, 42%, P = 0.118), along with more total colectomies in the laparoscopic group (7 vs 2). Operation times in the laparoscopic group were longer (197.5 min (87-452 min) vs 144 min (70-260 min), P = 0.0002) and no significant reduction was recorded over the study period (P = 0.50). There were five conversions from laparoscopic to open procedure (a 10% incidence). Compared with the open colectomy group, patients who underwent laparoscopic resections required less parenteral analgesia (2 days (1-5 days) vs 3 days (0-6 days), P < 0.0001). They had earlier first flatus (3 days (1-7 days) vs 4 days (1-6 days), P = 0.0069) and bowel movement (3 days (1-7 days) vs 4 days (2-9 days), P = 0.0021), tolerated solid diet earlier (3 days (1-9 days) vs 4 days (1-30 days), P = 0.0001) and had shorter hospital stay (5 days (3-12 days) vs 7 days (4-37 days), P = 0.0009). Less major perioperative complications were recorded for the laparoscopic group (2/50 vs 4/33, P = 0.162), but very little difference was found with respect to minor complications (17/50 vs 10/33, P = 0.725). For carcinoma resections, there were no positive resection margins. In the laparoscopic group, tumour size was smaller (3.25 cm (1-7 cm) vs 5 cm (2-15 cm), P = 0.0014) and less lymph nodes were harvested (6 (2-16) vs 8 (3-23), P = 0.101).

Conclusion: Laparoscopic colectomy allowed early postoperative recovery and shorter hospital stay. This was at the expense of a longer operation. It can be taken up by relatively laparoscopically naive surgeons without extra major morbidity/mortality associated with the learning curve. It is technically feasible and safe in small centres.