Universität zu Köln

Brockhaus, A. C., Politt, D., Lindlohr, C. and Saad, S. (2016). Transanal extraction vs. minilaparotomy. For laparoendoscopic left-sided colon resection. Chirurg, 87 (12). S. 1054 - 1063. NEW YORK: SPRINGER. ISSN 1433-0385

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Abstract

Recent developments in classical minimally invasive surgical procedures for colon resection aimed to minimize or even eliminate abdominal wall incisions, thus improving postoperative pain, patient recovery and aesthetics. A promising approach is the total laparoendoscopic colectomy (LEC) with transanal sample extraction. The aim of this study was the comparison of total LEC with conventional laparoscopic assisted surgery (LAS) and extraction incision. We included 168 consecutive patients (LEC:112; LAS:56) with diverticular disease, rectal prolapse, benign or malignant tumors and analyzed retrospectively. The specimen was extracted transanally by LEC with a specially developed rectoscope; the LAS group required a minilaparotomy of 5 cm. The primary outcome was postoperative pain. Secondary outcomes included operating time, minor and major complication rates, number and length of extracted specimens, additional pain medication and duration of hospital stay. The measured postoperative pain score values did not significantly differ between the two groups; however, consumption of postoperative pain medication was significantly higher in the LAS-group (p < 0.001). Due to the learning curve, the median operating time in the LEC group (120 min) was slightly longer than in the LAS group (100 min); however, it was reduced to 95 min in the last 50 operations. Patients in the LEC group were discharged from hospital one day earlier (median duration of hospital stay 6 days, p = 0.003). Compliaction rates were similar in both groups. The technique of total LEC with transanal specimen extraction is designed to avoid a minilaparotomy and its associated morbidities. The LEC operation is feasible for a large group of patients, including overweight patients. The superiority of LEC in terms of reduced pain medication, shorter hospital stay and faster patient recovery, as shown in this study, needs to be confirmed by randomized controlled trials with longer follow-up periods.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Brockhaus, A. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Politt, D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lindlohr, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Saad, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-254126
DOI:	10.1007/s00104-016-0263-5
Journal or Publication Title:	Chirurg
Volume:	87
Number:	12
Page Range:	S. 1054 - 1063
Date:	2016
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1433-0385
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LAPAROSCOPIC COLORECTAL SURGERY; ORIFICE SPECIMEN EXTRACTION; INCISIONAL HERNIA; SITE LOCATION; COLECTOMY; CANCER; DIVERTICULITIS; LAPAROTOMY; MIDLINE; TUMORS Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/25412