BACKGROUND/AIMS: Early reports of laparoscopic approaches for complex colectomies utilized a 5- or 6-incision technique, including a Pfannenstiel incision for rectal mobilization. The approach has been simplified to 4-incisions and all mobilization is performed intracorporeally. The aim of this pilot study was to assess the feasibility and possible benefits of a simplified technique for laparoscopic TAC-IRA for STC.
METHODS: Ten consecutive patients undergoing laparoscopic TAC-IRA (LAP group) between 6/98 and 10/00 were compared with 8 controls undergoing open TAC-IRA (OPEN group). Non-parametric analysis of data was performed with Mann-Whitney rank sum test.
RESULTS: All patients were female. All had confirmed slow colonic transit: 16 had a 24-hr geometric mean <1.6 and/or 48-hr mean <3.0 on scintigraphic study (range 1.1-1.8 at 24 hr, 1.6-2.8 at 48 hr); 2 patients had prolonged transit time with marker study. Pelvic floor dysfunction was absent in 12 and corrected preoperatively in 6. There was no significant difference in age (LAP median 31 yrs vs. OPEN 38 yrs, P=0.29), nor in body mass index (LAP 20.62 vs OPEN 22.50, P=0.27). Operative time was significantly longer in the Lap group, 247 vs 174 mins, P=0.04. All postoperative outcomes measured were significantly improved in the LAP group (Table). There was no significant difference in post-op morbidity, with 4 complications in LAP group vs. 7 in OPEN, P=NS.
CONCLUSIONS: The laparoscopic approach resulted in a shortened period of ileus, and a reduced requirement for narcotics, thus facilitating earlier discharge with no increase in complications.
Postoperative Outcomes
Outcome LAP (N=10) OPEN (N=8) P-Value
Days to clears 2.0 (1-2) 4.5 (4-5) 0.023
Days to reg diet 3.0 (2-4) 6.0 (5.5-7.5) 0.014
Days to BM 2 (2-3) 4.5 (4-5) <0.001
Hospital stay 4 (4-7) 8 (7-10.5) 0.011
IV narcotics (shifts) 8 (6-9) 14.5 (11-18.5) 0.004
Results are given as median (interquartile range)
