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Comparative Study
. 2012 Aug 7;18(29):3869-74.
doi: 10.3748/wjg.v18.i29.3869.

A totally mini-invasive approach for colorectal laparoscopic surgery

Gabriele Anania  1 , Mirco Santini, Lucia Scagliarini, Alice Marzetti, Laura Vedana, Serafino Marino, Claudio Gregorio, Giuseppe Resta, Giorgio Cavallesco
Affiliations
Comparative Study

A totally mini-invasive approach for colorectal laparoscopic surgery

Gabriele Anania et al. World J Gastroenterol. .

Abstract

Aim: To study the short-term outcome of patients treated with laparoscopic right colectomy and how intracorporeal anastomosis has improved the outcome.

Methods: We retrospectively examined all patients affected by colorectal cancer who underwent a laparoscopic right colectomy between January 2006 and December 2010 in our department. Our evaluation criteria were: diagnosis of colorectal carcinoma at presurgical biopsy, elective surgery, and the same surgeon. We excluded: emergency surgery, conversions from laparotomic colectomy, and other surgeons. The endpoints we examined were: surgical time, number of lymph nodes removed, length of stay (removal of nasogastric tube, bowel movements, gas evacuation, solid and liquid feeding, hospitalization), and major complications. Seventy-two patients were divided into two groups: intracorporeal anastomosis (39 patients) and extracorporeal anastomosis (33 patients).

Results: Significant differences were observed between intracorporeal vs extracorporeal anastomosis, respectively, for surgical times (186.8 min vs 184.1 min, P < 0.001), time to resumption of gas evacuation (3 d vs 3.5 d, P < 0.001), days until resumption of bowel movements (3.8 d vs 4.9 d, P < 0.001), days until resumption of liquid diet (3.5 d vs 4.5 d, P < 0.001), days until resuming a solid diet (4.6 d vs 5.7 d, P < 0.001), and total hospitalization duration (7.4 d vs 8.5 d, P < 0.001). In the intracorporeal group, on average, 19 positive lymph nodes were removed; in the extracorporeal group, on average, 14 were removed P < 0.001). Thus, intracorporeal anastomosis for right laparoscopic colectomy improved patient outcome by providing faster recovery of nutrition, faster recovery of intestinal function, and shorter hospitalization than extracorporeal anastomosis.

Conclusion: Short-term outcomes favor intracorporeal anastomosis, confirming that a less traumatic surgical approach improves patient outcome.

Keywords: Anastomosis; Cancer; Colorectal disease; Laparoscopy; Surgery.

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Figures

Figure 1
Figure 1
Intracorporeal anastomosis and extracorporeal anastomosis were no significant differences in the diagnosis from the pre-surgery biopsy. A: Intracorporeal anastomosis; B: Extracorporeal anastomosis.
Figure 2
Figure 2
Patients in the intracorporeal group and extracorporeal group went home within 7 d. A: Intracorporeal group; B: Extracorporeal group.
See this image and copyright information in PMC

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