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Laparoscopic Colectomy (laparoscopic + colectomy)

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Medical Sciences	100%

Selected Abstracts

Is laparoscopic colectomy as cost beneficial as open colectomy?

ANZ JOURNAL OF SURGERY, Issue 4 2009
Asim Shabbir
Abstract Background:, Laparoscopic colectomy has yet to gain widespread acceptance in cost-conscious health-care institutions. The aim of the present study was to define the cost,benefit relationship of laparoscopic versus open colectomy. Methods:, Thirty-two consecutive patients undergoing elective laparoscopic colectomy (LC) by a single colorectal surgeon between August 2004 and September 2005 were reviewed. Cases were matched with a historical cohort undergoing elective open colectomy (OC) between June 2003 and July 2004. Demography, perioperative data, histopathology and cost were compared. Results:, Both groups had similar demographics. Most resections (90.6%) were for cancer. Operative time was significantly longer for LC compared to OC (180 min vs 110 min, P < 0.001). Four patients (12.5%) in the LC group required conversion. LC patients, however, had lower median pain scores (3, 2 and 1 vs 6, 4 and 2 at 24, 48 and 72 h postoperatively, P < 0.001), faster resolution of ileus (3 vs 4 days, P < 0.001) and earlier discharge (6 vs 9 days, P < 0.001) compared to the OC group. As a result, overall hospital cost for both procedures was not significantly different (US$7943 vs US$7253, P = 0.41). Conclusion:, Laparoscopic colectomy is as cost-beneficial in the short term as open colectomy. [source]

CR10 LAPAROSCOPIC RIGHT HEMICOLECTOMY PERFORMED DURING THE ,LEARNING CURVE PHASE' DOES NOT IMPACT ON ONCOLOGICAL RESECTION

ANZ JOURNAL OF SURGERY, Issue 2007
E. Mignanelli
Purpose Laparoscopic colectomy for the management of colonic neoplasia is technically feasible and increasingly popular. It is expected that the laparoscopic operation deliver similar oncological clearance to open operation. The ,learning curve' for laparoscopic right hemicolectomy has been estimated to be 20 cases and is now set as a guideline by ASCRS. This study was performed to compare histopathology specimens following laparoscopic right hemicolectomy (LRH) performed during the ,learning curve' phase with those following open right hemicolectomy (ORH) to evaluate oncological clearance of colonic neoplasms. Methods 125 patients were identified as having undergone right hemicolectomy by two surgeons for colonic neoplasia from January 2001. Data regarding patient details and tumour pathology were obtained by retrospective case note review. Thirty-five patients underwent LRH compared to 90 who had ORH during the same period. Histopathology from the two groups were compared for length of specimen resected, proximal and distal resection margins, size of tumour resected or number of lymph nodes harvested. Analysis was performed using Student's T-test. Results The two groups were matched with respect to age, sex and tumour characteristics. There was no significant difference between the groups in terms of length of specimen resected (p = 0.37), proximal (p = 0.29) and distal (p = 0.40) resection margins, size of tumour resected (p = 0.37) or number of lymph nodes harvested (p = 0.58). Conclusions ,Learning curve' laparoscopic right hemicolectomy allows similar lymphovascular clearance to traditional open surgery. [source]

Laparoscopic emergency and elective surgery for ulcerative colitis

COLORECTAL DISEASE, Issue 4 2008
L. Fowkes
Abstract Objective, To analyse surgical outcomes of fulminate and medically resistant ulcerative colitis (UC) carried out laparoscopically. Method, A prospective database identified 69 consecutive patients who underwent surgery for UC under the senior author over a 5-year period to April 2006. Results, Thirty-two patients (18 male patients), median BMI 26, underwent laparoscopic subtotal colectomy (LSTC): 22 acute emergencies, 10 refractory to medical therapy and unfit for restorative proctocolectomy. All were receiving iv steroids; azathioprine (7), cyclosporin (5). The median operation time was 135 min (65,280). There was one conversion. Twenty-nine patients have subsequently undergone completion proctectomy and W-pouch formation [24 patients were performed laparoscopically , laparoscopic completion proctectomy (LCP)]; widespread adhesions precluded in five patients. Twenty-six patients underwent restorative laparoscopic proctocolectomy (LRP) , one conversion. Twenty patients underwent W-pouch reconstruction via a Pfannenstiel incision. Six J-pouches were constructed and returned via the ileostomy site. Three underwent a laparoscopic pan-proctocolectomy (LPPC); one conversion. Eight patients underwent open STC. The median time to normal diet was 48 h (1,7 days) for LSTC/LCP and 36 h (1,5 days) for LRP. There were two major complications following LRP, two following LSTC, one following LCP, one following LPPC and five following open surgery. Median hospital stay was 8 days (6,72) for LSTC, 7 days (6,9) for LCP and 5 days (3,45) for LRP. There were six 30-day readmissions following laparoscopic surgery (DVT, reactive depression, ileostomy hold up (2), abdominal pain and high output ileostomy). Conclusion, Laparoscopic subtotal and restorative proctocolectomies in fulminate and medically resistant UC are feasible, safe and largely predictable operations that allow for early hospital discharge. Laparoscopic colectomy facilitates subsequent proctectomy and pouch construction. [source]

Laparoscopic colectomy is cheaper than conventional open resection

COLORECTAL DISEASE, Issue 9 2007
P. F. Ridgway
Abstract Objective, International randomized trials have endorsed the routine use of laparoscopic techniques in colorectal surgery. The authors hypothesize that the overall care pathway in minimal access resection was cheaper than conventional open resection. Method, This was a case-matched study of consecutive patients undergoing laparoscopic resection between July 2005 and February 2006. Intraoperative (costs, duration, incision length) and postoperative [morbidity, length of stay (LOS), readmission] parameters were examined. Institutional retrospective open controls and national validated figures were used for costings. Results, Thirty-five laparoscopic and 53 open resections were evaluated. Median LOS was 5 days in the laparoscopic group vs 12 in the open group (P = 0.001). There were two conversions (5.7%) and two readmissions. Mean operative cost of laparoscopic resection was ,1557.08, therefore 2.4 bed days need to be saved to recoup the increased cost compared with open resection. The actual median save is 7 days (P = 0.031). A mean of ,4591.38 and 7 bed days per case is saved by performing the resection laparoscopically. Subgroup analysis of laparoscopic resections clearly demonstrates similar trends. Conclusion, The institutional saving is over ,150 000 and 245 bed days during the study period. Despite higher operative spending, laparoscopic colorectal resections are significantly cheaper than conventional open resections. [source]

Laparoscopic colonic resection in inflammatory bowel disease: minimal surgery, minimal access and minimal hospital stay

COLORECTAL DISEASE, Issue 9 2008
E. Boyle
Abstract Objective, Laparoscopic surgery for inflammatory bowel disease (IBD) is technically demanding but can offer improved short-term outcomes. The introduction of minimally invasive surgery (MIS) as the default operative approach for IBD, however, may have inherent learning curve-associated disadvantages. We hypothesise that the establishment of MIS as the standard operative approach does not increase patient morbidity as assessed in the initial period of its introduction into a specialised unit, and that it confers earlier postoperative gastrointestinal recovery and reduced hospitalisation compared with conventional open resection. Method, A case,control study was undertaken on laparoscopic resection (LR) vs open colon resection (OR) for IBD. The LR group was collated prospectively and compared with a pathologically matched historical control set. Outcomes measured included: postoperative length of stay, time to normal bowel function and postoperative morbidity. Statistical analysis was performed using spss. Results, Twenty-eight patients were investigated (14 LR, 14 OR). The two groups were matched for type of operation, type of disease and age. There were no conversions in the LR group. Morbidity and readmissions did not differ significantly between the groups. Those undergoing laparoscopic resection had a quicker return to diet (median 2 vs 4 days; P = 0.000002), time to first bowel motion (2 vs 4 days; P = 0.019) and shorter postoperative length of stay (5.5 vs 12.5; P = 0.0067). Conclusion, These findings support the routine use of MIS for the elective surgical management of IBD in our department. Patients undergoing laparoscopic colectomies for IBD can expect faster return of gastrointestinal function and shorter hospitalisation. [source]

Perspective on ,is laparoscopic colectomy as cost-beneficial as open colectomy'

ANZ JOURNAL OF SURGERY, Issue 4 2009
FRCS (Gen), Henry Dowson BSc, MB BS
No abstract is available for this article. [source]

Is laparoscopic colectomy as cost beneficial as open colectomy?

Tumor recurrence at a stapled-anastomosis after radical laparoscopic surgery for descending colon cancer treated successfully by laparoscopic colectomy: A case report

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2010
LQ Nhan
Abstract Anastomosis using linear staplers following colonic resection has been increasingly used due to its convenience and technical safety. However, there have been few reports of stapled-anastomotic recurrence after curative resection for colon cancer. Here, we report a rare case of suture-line recurrence after functional end-to-end anastomosis. A 78-year-old woman underwent radical laparoscopic colectomy for advanced descending colon cancer. A postoperative 1 year follow-up colonoscopy revealed that suture-line recurrence had occurred. After the detection of early stage recurrent cancer, the patient underwent laparoscopic partial colectomy. This rare case of suture-line recurrence in functional end-to-end anastomosis possibly occurred due to tumor implantation after curative laparoscopic surgery for advanced descending colon cancer. The follow-up colonoscopy was helpful in diagnosing the anastomotic recurrence in its early stages. In addition, laparoscopic surgery for primary colon cancer led to successful laparoscopic treatment for recurrent cancer as a result of reduced bowel adhesion. [source]

Laparoscopic colorectal cancer surgery: Japanese experience

ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2009
F Konishi
Abstract In Japan, laparoscopic colectomy for cancer started in 1992. A national survey has revealed that, since that time, the number of cases that have undergone this procedure has steadily increased, and by 2007, there were over 9000 cases. This figure includes an increase in the percentage of more advanced cases, which has occurred due to technical improvements in lymph node dissection. A Japanese randomized controlled trial comparing laparoscopic to open surgery started in November 2004, with enrollment ending in April 2009 with 1050 cases. For this study, preoperative stage T3 and T4 cases were selected for inclusion, and D3 dissection was required. To assess the technical skill of surgeons, the Japan Society of Endoscopic Surgery established the Endoscopic Surgical Skill Qualification System to encourage high-level surgical techniques. Assessment is conducted by reviewing unedited videos. The success rate for colon and rectal surgeries has ranged between 37%,40%. The Endoscopic Surgical Skill Qualification System has contributed to the establishment of standard technical skills in laparoscopic surgery, the development of an educational system for laparoscopic surgeons, and a reduction in the number complications. Technical difficulties still exist in laparoscopic rectal cancer surgery, but with the technical progress in laparoscopic colorectal surgery, the number of laparoscopic rectal cancer surgeries has been gradually increasing in number. A multicentric phase II study on the feasibility and long-term outcome for stage I and II rectal cancer started in 2008. In this study, the short-term outcomes including anastomotic leakage rate and long-term survival, will be clarified. Combined with continuously improved technologies, training techniques and surgical standards, laparoscopic colorectal surgery is steadily progressing in Japan. [source]

Evaluation of POSSUM and P-POSSUM scoring systems in assessing outcome after laparoscopic colectomy (Br J Surg 2003; 90: 1280,1284)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 12 2003
K. Slim
No abstract is available for this article. [source]