The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study

Abstract

Purpose: To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia.

Methods: From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups.

Results: All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05).

Conclusion: HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.

Keywords: Constipation; Hand-assisted laparoscopy; Proctocolectomy.

Fig. 1

Trocar and device placement. a, supraumbilical port for laparoscope; b and c, accessory port for harmonic scalpel; d, suprapubic transverse incision for LapDisc system.

Fig. 2

Trocar and device placement. a-d, accessory port for laparoscope and harmonic scalpel; e, incision for LapDisc system.