J Korean Surg Soc.  2013 Sep;85(3):123-127. 10.4174/jkss.2013.85.3.123.

The role of hand-assisted laparoscopic surgery in total colectomy for colonic inertia: a retrospective study

• Wang DY
• Lin JJ
• Xu XM
• Liu FL

• KMID: 1426344
• DOI: http://doi.org/10.4174/jkss.2013.85.3.123

Abstract

PURPOSE
To compare and assess the efficacy, safety and utility of hand-assisted laparoscopic surgery (HALS) with open surgery (OS) in total colectomy with ileorectal for colonic inertia.
METHODS
From January 2001 to February 2012, 56 patients diagnosed with colonic inertia who failed to respond to medical treatments underwent hand-assisted laparoscopic total colectomy with ileorectal anastomosis. Another 68 patients underwent laparotomy. Main parameters such as clinical manifestations, conversion to open procedure, operative time, incision length, pain score, intraoperative blood loss, time to first flatus and hospitalization, early postoperative complications and hospitalization cost were retrospectively analyzed. Postoperative defecating frequencies were followed up in both groups.
RESULTS
All patients received successful operation, no surgical mortality happened and none of the patients required conversion to an exploratory laparotomy in HALS group. The clinical features, the estimated blood loss, incision length, pain score, first passing flatus time, and postoperative hospitalization time were superior in HALS group (P < 0.05). The early postoperative complications and frequency of defecation were similar. However, the mean operative time was longer and hospitalization cost was higher in HALS group than those in OS group (P < 0.05).
CONCLUSION
HALS total colectomy can be a safe and efficient technique in the treatment of colonic inertia. HALS can result in a better cosmetic result and a quicker postoperative recovery, but requires higher direct cost.

Keyword

Hand-assisted laparoscopy; Proctocolectomy; Constipation

MeSH Terms

Colectomy
Colon
Constipation
Cosmetics
Defecation
Flatulence
Hand-Assisted Laparoscopy
Hospitalization
Humans
Laparotomy
Operative Time
Postoperative Complications
Retrospective Studies
Surgical Procedures, Operative
Cosmetics

Figure

• 

  Fig. 1 Trocar and device placement. a, supraumbilical port for laparoscope; b and c, accessory port for harmonic scalpel; d, suprapubic transverse incision for LapDisc system.

• 

  Fig. 2 Trocar and device placement. a-d, accessory port for laparoscope and harmonic scalpel; e, incision for LapDisc system.

Reference

1. Webster C, Dayton M. Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surg. 2001; 182:639–644.

2. Sohn G, Yu CS, Kim CW, Kwak JY, Jang TY, Kim KH, et al. Surgical outcomes after total colectomy with ileorectal anastomosis in patients with medically intractable slow transit constipation. J Korean Soc Coloproctol. 2011; 27:180–187.

3. Ozturk E, Kiran RP, Remzi F, Geisler D, Fazio V. Hand-assisted laparoscopic surgery may be a useful tool for surgeons early in the learning curve performing total abdominal colectomy. Colorectal Dis. 2010; 12:199–205.

4. Leahy PF, Bannenberg JJ, Meijer DW. Laparoscopic colon surgery: a difficult operation made easy. Surg Endosc. 1994; 8:992.

5. Nakajima K, Lee SW, Cocilovo C, Foglia C, Sonoda T, Milsom JW. Laparoscopic total colectomy: hand-assisted vs standard technique. Surg Endosc. 2004; 18:582–586.

6. Nakajima K, Nezu R, Hirota M, Nishida T. The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn's colitis. Surg Endosc. 2010; 24:2713–2717.

7. Hsiao KC, Jao SW, Wu CC, Lee TY, Lai HJ, Kang JC. Hand-assisted laparoscopic total colectomy for slow transit constipation. Int J Colorectal Dis. 2008; 23:419–424.

8. Rao SS. Constipation: evaluation and treatment. Gastroenterol Clin North Am. 2003; 32:659–683.

9. Bassotti G, Villanacci V. Slow transit constipation: a functional disorder becomes an enteric neuropathy. World J Gastroenterol. 2006; 12:4609–4613.

10. Toman J, Turina M, Ray M, Petras RE, Stromberg AJ, Galandiuk S. Slow transit colon constipation is not related to the number of interstitial cells of Cajal. Int J Colorectal Dis. 2006; 21:527–532.

11. Ky AJ, Sonoda T, Milsom JW. One-stage laparoscopic restorative proctocolectomy: an alternative to the conventional approach? Dis Colon Rectum. 2002; 45:207–210.

12. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991; 1:144–150.

13. Reichenbach DJ, Tackett AD, Harris J, Camacho D, Graviss EA, Dewan B, et al. Laparoscopic colon resection early in the learning curve: what is the appropriate setting? Ann Surg. 2006; 243:730–735.

14. Meshikhes AW. Controversy of hand-assisted laparoscopic colorectal surgery. World J Gastroenterol. 2010; 16:5662–5668.

15. Ou H. Laparoscopic-assisted mini laparatomy with colectomy. Dis Colon Rectum. 1995; 38:324–326.

16. Litwin DE, Darzi A, Jakimowicz J, Kelly JJ, Arvidsson D, Hansen P, et al. Hand-assisted laparoscopic surgery (HALS) with the HandPort system: initial experience with 68 patients. Ann Surg. 2000; 231:715–723.

17. Liu FL, Lin JJ, Ye F, Teng LS. Hand-assisted laparoscopic surgery versus the open approach in curative resection of rectal cancer. J Int Med Res. 2010; 38:916–922.

18. Kim HJ, Choi GS, Park JS, Park SY, Choi WH, Ryuk JP. Early postoperative and long-term oncological outcomes of laparoscopic treatment for patients with familial adenomatous polyposis. J Korean Surg Soc. 2012; 83:288–297.

19. Chung CC, Ng DC, Tsang WW, Tang WL, Yau KK, Cheung HY, et al. Hand-assisted laparoscopic versus open right colectomy: a randomized controlled trial. Ann Surg. 2007; 246:728–733.

20. Maartense S, Dunker MS, Slors JF, Cuesta MA, Gouma DJ, van Deventer SJ, et al. Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial. Ann Surg. 2004; 240:984–991.

21. Kang JC, Chung MH, Chao PC, Yeh CC, Hsiao CW, Lee TY, et al. Hand-assisted laparoscopic colectomy vs open colectomy: a prospective randomized study. Surg Endosc. 2004; 18:577–581.