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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy: A critical appraisal (1993)
    Springer
    Diseases of the colon & rectum 36 (1993), S. 28-34 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopy ; Laparoscopic colectomy ; Colectomy ; Colon resection ; Colon and rectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups (P 〈0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group (P 〈 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050298
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy yields similar morbidity and disability regardless of patient age (1999)
    Springer
    International journal of colorectal disease 14 (1999), S. 155-157 
    Details
    ISSN: 1432-1262
    Keywords: Key words Laparoscopy ; Colectomy ; Age ; Morbidity ; Disability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  This study compared the outcome factors of morbidity and the length of disability in older and younger patients following laparoscopic colorectal surgery. All patients undergoing laparoscopic segmental resection during the study period were included. Morbidity was determined by reviewing the medical records, and disability by a patient-administered questionnaire. The series was divided into two age cohorts (≤64 and ≥65 years), which did not differ significantly in gender or type of procedure. Between these two groups we found no significant differences in mean duration of ileus (3.3 days in both groups), the mean length of hospitalization (5.7 vs. 6.3 days, respectively), morbidity rate (18% vs. 21%), or time until returning to partial activity (1.6 vs. 1.6 weeks) or to full activity (3 vs. 2 weeks). Our findings demonstrate that neither the morbidity rate nor the disability period after laparoscopic techniques differ between elderly and younger patients. We therefore endorse the use of laparoscopy regardless of patient age.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050202
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    An initial comparative study of two techniques of laparoscopic colonic anastomosis and mesenteric defect closure (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 130-134 
    Details
    ISSN: 1432-2218
    Keywords: Laparotomy ; Laparoscopy ; Colectomy ; Anastomosis ; Colorectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Laparoscopic colon and rectal surgery is still in its nascent stages of development. The ease, efficacy, and safety of intracorporeal mechanical colonic anastomosis are contingent upon expensive stapling devices. Although mobilization and mesenteric division are feasible, a method of inexpensive rapid anastomosis is not. A single inexpensive multifire stapler which could be used both to fashion the anastomosis and to close the mesenteric defect would be ideal. Therefore, this prospective randomized study was undertaken to compare the clinical and functional results of laparoscopic colotomy closure performed using the Endopath EMS hernia stapler (EMS; Ethicon Endosurgery Inc., Cincinnati, OH) to results of using standard two-layer hand suturing (HS). Both the colotomy itself and the mesenteric defect closure sites were included in the randomization and analysis. The abdominal cavity was assessed for evidence of anastomotic leakage, abscess, and adhesion formation. In addition, radiographic luminal diameter, bursting strength, and histology were evaluated. Eight healthy pigs were randomized to either the EMS (N=4) or HS (N=4). There was no evidence of leakage, abscesses, or adhesion formation in either group; however, the mesenteric defect revealed more scarring in the HS than in the EMS animals. There were no significant differences in either luminal diameter (HS: mean=0.92 cm; EMS: mean=0.91 cm) or bursting strength (HS: mean=171 mm Hg; EMS: mean=157 mm Hg) (P〉0.05). Histologic analysis also demonstrated no difference in inflammation, necrosis, or fibrosis. This study suggests that this technique can be safely applied to both colotomy closure and mesenteric defect repair. Clinical, histopathologic, and functional results after EMS closure are comparable to standard (HS) closure. Reproduction of this inexpensive means of safe, cost-effective, intracorporeal anastomosis and mesenteric closure should be pursued in human clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00316626
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  • 4
    Electronic Resource
    Electronic Resource
    Colonoscopic-assisted laparoscopic colectomy (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 1352-1353 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Colectomy ; Colonoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract One of the technical difficulties during laparoscopic and laparoscopic-assisted resection of the right, transverse, and left colon is the mobilization of the splenic and hepatic flexures. We present a simple technique of colonoscopic traction of the splenic or hepatic flexure. This technique enables good exposure and facilitates dissection while laparoscopic mobilization of these segments of the colon is performed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188301
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  • 5
    Electronic Resource
    Electronic Resource
    Laparoscopic colorectal surgery (1996)
    Springer
    Surgical endoscopy and other interventional techniques 10 (1996), S. 133-136 
    Details
    ISSN: 1432-2218
    Keywords: Laparoscopy ; Colectomy ; Laparoscopic colorectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study was performed to prospectively assess the results of our first 140 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal operations. Methods: The parameters studied included the type and length of procedure, intra- and postoperative complications, conversion to open surgery, and length of ileus and hospitalization. Results: 140 laparoscopic and laparoscopic-assisted procedures were performed between May 1991 and January 1995. The mean patient age was 48 (range 12–88) years; there were 78 males and 62 females. Indications for surgery included inflammatory bowel disease in 47, colorectal carcinoma in 19, diverticular disease in 17, polyps in 16, familial polyposis in 7, colonic inertia in 7, fecal incontinence in 11, sigmoidocele in 3, irradiation proctitis in 3, rectal prolapse in 2, intestinal lymphoma in 2, and miscellaneous conditions in 6. The procedures included 38 total abdominal colectomies (TAC) (ileoanal reservoir 28, ileorectal anastomosis 8 and end ileostomy 2); 70 segmental resections of the colon, small bowel, and rectum; 18 diverting stoma creations; 10 reversal of Hartmann's procedures; and 4 other procedures. In 15 cases, the laparoscopic procedure was converted to a laparotomy (11%); 31 patients (22%) sustained 37 complications, which included: enterotomies (7), hemorrhage (10), intraabdominal abscess (4), prolonged ileus (6), wound infection (4), intestinal obstruction (2), anastomotic leak (1), aspiration (1), cardiac arrhythmia (1), and upper intestinal bleeding (1); there was no mortality. The overall complication rate in TAC cases was significantly higher (42%) when compared to that of all other procedures (segmental resection 17%, others 9%), P〈0.05. The mean length of operating time was 4 (range 2.5–6.5) h for TAC, 2.6 (range 1.5–5.5) h for segmental colonic resections, and 1.7 (range 0.7–4) for all other procedures. The length of ileus was 3.5 (range 2–7) days after TAC, 3 (range 2–7) after the segmental resections and 2 (range 1–4) after the other procedures. The mean length of hospital stay was 6.8 (2–40) days (8.4, 6.5, and 6.3 days for the TAC, segmental resections, and other procedures, respectively). Conclusion: The feasibility of laparoscopic colorectal surgery has been well established. TAC is associated with a higher complication rate compared to other laparoscopic colorectal procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00188358
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    Paper (German National Licenses)
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