Laparoscopic operating techniques are gaining
wider acceptance among colorectal surgeons, as their efficacy is
proven. These techniques offer patients the advantages of fewer
complications, decreased need for postoperative narcotics, faster
return to normal bowel function, and shorter hospital stays.
Laparoscopy typically requires incisions of 2 to 3 inches or less,
compared to the 12- to 18-inch incision required for conventional
open bowel resection.
At the 100th annual meeting of the American Society of Colon and
Rectal Surgeons (ASCRS), a series of presentations heralded the
positive results achieved with laparoscopy in both older and younger
patients. Outcomes were satisfactory in curative surgeries performed
for colon cancer, familial polyposis, ulcerative colitis,
uncomplicated diverticulitis, and Crohns disease.
Cancer outcome at 2 years is not compromised by a laparoscopic
assisted approach, said Brian J. Mehigan, MB, BCH, based on a
study of 111 patients who underwent cancer surgery at the University
of Hull, Castle Hill Hospital, United Kingdom.
A laparoscopic resection for colorectal cancer can give good
intermediate term cancer outcomes, said Dr. Andrew Stevenson,
reporting on a study of 180 patients at Royal Brisbane Hospital in Australia.
Laparoscopic techniques reduced the length of hospital stay from 10.2
to 6.5 days in a study of 84 elderly patients (mean age, 80+ years)
at the Mayo Clinic, Rochester, Minnesota. Laparoscopic-assisted
colectomy is safe and beneficial to the elderly, said Heidi
The mean patient age was only 21 years in a comparative study of
laparoscopic vs open surgery involving 76 patients treated at the
Cleveland Clinic, Cleveland, Ohio. These patients underwent surgery
for familial polyposis and ulcerative colitis. For this young
patient population, a laparoscopic approach may be an appealing
alternative, said Peter W. Marcello, MD.
Patients with uncomplicated diverticulitis patients in Norfolk,
Virginia, who had laparoscopic surgery returned to a regular diet
only 3.5 days after surgery, compared to 5.2 days for open surgery
patients, said H. David Vargas, MD Length of hospital stay was also
shorter, 4.2 vs 6.4 days. Dr. Vargas described laparoscopy as a
reasonable option for recurrent, uncomplicated diverticulitis
but said open surgery may still be preferred for complicated diverticulitis.
A prospective, randomized trial of 60 patients with Crohns
disease, conducted at Mt. Sinai Medical Center, New York City, showed
faster recovery of pulmonary function, fewer complications, and
shorter hospital stays compared to conventional open surgery.
There were no apparent short-term disadvantages, said
Jeffrey Milson, MD