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Background: Conventional laparoscopic assisted right hemicolectomy (LARH) involves making an abdominal incision to remove the specimen and perform the anastomosis. The skin incision extraction site continues to be a major source of morbidity after both open and LARH, specifically with regard to postoperative pain, wound infection and hernia formation. Totally laparoscopic right hemicolectomy with intracorporeal anastomosis and transvaginal extraction ie. natural orifice specimen extraction (NOSE) eliminates the skin incision extraction site and may possible leads to better outcome compared to LARH.
Methods: Our study reviewed two consecutive case matched cohorts: LARH and NOSE performed during 2007 and 2011. Forty consecutive female patients total were reviewed: 20 LARH and 20 NOSE. The two groups were matched for benign and malignant disease, sex, age, race, American Society of Anesthesiologist (ASA) score, pathology, tumor stage, lymph node (LN) number, body mass index (BMI), previous abdominal surgeries, and comorbidities including chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), hypertension, diabetes mellitus (DM), chronic kidney disease (CKD), and nicotine dependence. Our goal was to determine significant differences between the two groups with regard to postoperative pain, wound infection, hernia formation, postoperative ileus, septic complications, length of hospital stay, readmission rate, time interval for postoperative chemotherapy if indicated, symptom distress score (SDS), Visick grade, Quality of life Index (QLI) and cosmetic score.
Results: The two groups were comparable for all categories. Follow up was available on all patients (100%). At a mean follow-up of 25.23 months (range 6-53, there was no difference between postoperative pain between the two groups on postoperative day one, postoperative day two or greater than 2 weeks (p= .571),(p= .861),(p= .688), respectively. The NOSE group had no postoperative hernia formation or wound infections compared to the LARH group which had 10% hernia formation rate and 5% wound infection rate, however the difference was not significant (p= .439)and(p=.267), respectively. There was no difference between groups in postoperative ileus (p=.192), septic complications (p=1.000), length of hospital stay (p=.243), readmission rate (p=.394), time interval for postoperative chemotherapy (p=.645), SDS (p=.446), Visick grade (p=.176) or QLI (p=.175). The NOSE group, however, have statically significant better cosmetic scores (p.018).
Conclusion: NOSE is comparable LARH with regard to short and long term postoperative outcomes. NOSE is associated with better cosmetic outcome.