Members Members Residents Job Board
Join Today Renew Your Membership Make A Donation
2004 Abstract: LAPAROSCOPIC TOTAL ABDOMINAL COLECTOMY IN THE ACUTE SETTING

LAPAROSCOPIC TOTAL ABDOMINAL COLECTOMY IN THE ACUTE SETTING

Publishing Number: 830

Michael R. Marohn, Eric J. Hanly, Kevin J. McKenna, Carmen R. Varin, Johns Hopkins University, Baltimore, MD

 

Objective: We report results from a single surgeons ten-year team experience with laparoscopic total abdominal colectomy. Previous reports of laparoscopic total colectomy have been mixed. We review our series, which includes a large subgroup of ill, high risk patients, requiring urgent surgery.

 

Methods: From 1993 to 2003, our group performed 65 laparoscopic total abdominal colectomies. All patients referred for total abdominal colectomy were offered a laparoscopic approach. We tracked patient demographics, surgical indications, preoperative status, duration of surgery, blood loss, complications, length of stay, subsequent surgeries, patient satisfaction, and lessons learned from our experience.

 

Results: Preoperative diagnoses included ulcerative colitis (85%), Crohns colitis (5%), colonic inertia (5%), and familial adenomatous polyposis (FAP) (5%). Among the inflammatory bowel disease patients, 70% of cases were performed on ill patients, refractory to medical management, requiring urgent surgery. This subgroup was managed with laparoscopic total abdominal colectomy and Brooke ileostomy, with ileo-anal pouch anastomosis deferred. Operative times were long, ranging from 6 to 9+ hours. Blood loss averaged ~200 cc. Length of stay ranged from 2 to 13 days, averaging 4.3 days. There were no conversions to open surgery and there were no deaths. Complications occurred in 12% of patients and included intra-abdominal abscess (2), wound infection (3), stoma stenosis (1), and incisional hernia (2). Postoperative patient satisfaction was high. Subsequent surgeries, including restorative proctectomy, were also performed laparoscopically.

 

Conclusions: Laparoscopic total abdominal colectomy is technically challenging and requires a team approach, but offers patients significant benefit in length of stay and surgical recovery, and can be effectively employed with minimal morbidity in difficult, ill patients requiring urgent surgery.

 

 




Society for Surgery of the Alimentary Tract

Facebook Twitter YouTube

Email SSAT Email SSAT
500 Cummings Center, Suite 4400, Beverly, MA 01915 500 Cummings Center
Suite 4400
Beverly, MA 01915
+1 978-927-8330 +1 978-927-8330
+1 978-524-0498 +1 978-524-0498
Links
About
Membership
Publications
Newsletters
Annual Meeting
Join SSAT
Job Board
Make a Pledge
Event Calendar
Awards