Laparoscopic- vs. Hand-Assisted Ultralow Anterior Resection: A Prospective Study
| Autor: | Chung Hung Yeh, Joe J. Tjandra, Miranda K. Y. Chan |
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| Rok vydání: | 2008 |
| Předmět: |
Male
Laparoscopic surgery medicine.medical_specialty medicine.medical_treatment Statistics Nonparametric Resection medicine Humans Prospective Studies Prospective cohort study Laparoscopy Neoplasm Staging Colectomy Chi-Square Distribution medicine.diagnostic_test Ileostomy Rectal Neoplasms business.industry Gastroenterology General Medicine Length of Stay Middle Aged Total mesorectal excision Colorectal surgery Endoscopy Surgery Treatment Outcome Female business |
| Zdroj: | Diseases of the Colon & Rectum. 51:26-31 |
| ISSN: | 0012-3706 |
| DOI: | 10.1007/s10350-007-9107-1 |
| Popis: | A standard laparoscopic-assisted operation can be conducted with colorectal anastomosis performed after extraction of specimen and insertion of a pursestring via a small left iliac fossa or suprapubic incision, or completed via hand-assisted laparoscopic technique with a 7-cm to 8-cm suprapubic incision. This study compares the short-term outcomes of either technique.Sixty-three consecutive patients undergoing laparoscopic-assisted ultralow anterior resection or total mesorectal excision for rectal cancer were examined. The laparoscopic-assisted group (n = 31) had standard laparoscopic-assisted resection, whereas the hand-assisted laparoscopic group (n = 32) had a 7-cm to 8-cm suprapubic incision to allow an open colorectal anastomosis. In patients who were obese or have had multiple abdominal surgeries, the hand-assisted approach was generally favored. All patients had a diverting ileostomy.There was no conversion in either group. Mean operating time was significantly longer in the laparoscopic-assisted group (188.2 vs. 169.8 minutes; P0.0001). Mean duration for narcotic analgesia (1.65 vs. 3.38 days, P0.0001), mean time to flatus (1.97 vs. 3.19 days, P0.0001), and mean duration of intravenous hydration (2.45 vs. 3.88 days, P0.0001) were longer in the hand-assisted laparoscopic group. However, the mean length of hospital stay (5.8 vs. 5.9 days, P = 0.379) was similar. There was no major surgical complication in either group; chest infection, wound infection, and thrombophlebitis were similar between the laparoscopic-assisted group and the hand-assisted laparoscopic group. Adequacy of specimen harvest (distal tumor margins, P = 0.995; circumferential resection margin, P = 0.946; number of lymph nodes, P = 0.845) was similar.Although both laparoscopic-assisted and hand-assisted laparoscopic surgeries are safe and feasible for ultralow anterior resection, the hand-assisted technique significantly shortens operating time. |
| Databáze: | OpenAIRE |
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