There is a spread of the laparoscopic technique on the field of colorectal surgery
also. At the 1st Dept Surgery of Semmelweis University we have been routinely performing
laparoscopic colonic operations since 2004. We analyze our 50 cases, which were operated
on between 1st January 2004 and 1st February 2006 in this paper. All these patients
underwent not only laparoscopic exploration, but also colorectal resection. The main
criterion of patient-selection – besides anesthesiology – was as follows: not suitable
for laparoscopic surgery if the tumor is in stage T4 and/or M1. On the other hand,
there was no exclusion based on age. Also, benign pathologies were operated. The average
age was 64 years; the ratio of women/men was 1:1.2. In 36 cases (72%), surgery for
malignant disease was performed. In this group, the tumor was located in the rectum
in 14 cases, in the sigmoid colon in 12 cases, in the descending colon in 1 case,
in the transverse colon in 1 case, on the right-side colon in 5 cases, and in the
coecum in tree cases consecutively. The indication was based on benign disease in
14 cases. The underlying pathology was polyps, IBD diverticulitis and endometriosis.
In two cases, abdomino-perineal excision was done. In the remaining cases, 39.6% of
the anastomosis was performed intra-corporally using a mechanical stapler. In the
other 60.4%, an extra-corporeal hand-sutured anastomosis was made. The dissection
of the mesentery – also including the major arteries – was done with a 10mm „Ligasure“
device. Conversion was needed in 8 cases (16%), in 3 cases because of intra-operative
injury.
The average operation time was 4 hours and 50 minutes. For 38 patients, there was
no complication of any kind. Anastomotic leakage was observed in two patients, and
the wound complication rate was as high as 10%.
The first postoperative stool happened on the third day on average. The average length
of postoperative stay was 7.7 days for the complication-free group, and 11 days for
those with some complication.
It is clear from our preliminary results that laparoscopic colorectal surgery can
be performed with results similar to open surgery. The presently long surgery time
could be significantly reduced with practice.
