Laparoscopic Surgery Offers Important Benefits for Patients With Colorectal Disease

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 Crohn’s disease.

Major Findings

• “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 Nelson, MD.

• 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 Crohn’s 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