Laparoscopy for benign colorectal diseases

Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach

A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twenty-four hours postoperatively, the patient’s pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.

Laparoscopic Colorectal Resection in Octogenarian Patients: Is it Safe? A Systematic Review and Meta-Analysis

The population older than 80 years has been increasing. A significant proportion of colorectal diseases that require colorectal resection occur in very elderly patients. However, the benefits of laparoscopy remain controversial in octogenarians. A systematic review and meta-analysis of observational study was performed to compare clinical outcomes between laparoscopic versus open colorectal resection in octogenarians.The PubMed, EMBASE, Ovid, Web of Science, and Cochrane databases from the years 1990 to 2015 were searched for studies that compare surgical outcomes between laparoscopic and open colorectal resection in octogenarians (≥80 years old).Seven eligible studies including 528 laparoscopic and 484 open colorectal resections were identified. Laparoscopic approach was associated with lower rate of mortality (odds ratio [OR] 0.48, P = 0.03), overall complications (OR 0.54, P < 0.001), and prolonged ileus (OR 0.56, P = 0.009), quicker bowel function return (standardized mean difference [SMD] -0.50, P< 0.001), and shorter length of hospital stay (SMD -0.47, P = 0.007). No differences were found in anastomotic leak (OR 1.16, P = 0.72), respiratory complication (OR 0.60, P = 0.07), and reoperation (OR 0.85, P = 0.69).Laparoscopic colorectal resection is as safe as open approach, and the short-term outcomes appear to be more favorable in octogenarians.

Comparison of transabdominal and transperineal procedures for complete rectal prolapse: Analysis of 104 cases

AIM: To evaluate and compare the clinical outcomes of transabdominal and transperineal surgical procedures for patients with complete rectal prolapse.

METHODS: A retrospective study was performed of patients with complete rectal prolapse who received surgical treatment at the Central Hospital of Xinxiang between March 1995 and May 2014. Patients were classified according to the type of operation: transabdominal procedure (n = 64) and transperineal procedure (n = 40). Clinical effects were compared for the two groups.

RESULTS: There were more young patients and males in the transabdominal group than in the transperineal group. Compared with the transperineal group, the transabdominal group had longer operating time (165 min ± 67 min vs 70 min ± 38 min, P < 0.001), longer hospital stay (10 d ± 4 d vs 7 d ± 2 d, P < 0.001), but a lower overall recurrence rate (6.3% vs 15.0%, P < 0.05). The overall rate of complications was similar between the two groups (10.9% vs 6.8%, P > 0.05). The patients in the transabdominal group complained more frequently of constipation than of incontinence, conversely, in the transperineal group of incontinence than of constipation.

CONCLUSION: The two approaches for treating complete rectal prolapse did not differ with regard to postoperative morbidity, but recurrence occurs frequently among patients in the transperineal group. Surgeons should carefully assess the condition of patients before operation and select the appropriate surgical approach for treating complete rectal prolapse.

Factors influencing laparoscopic colorectal operative duration and its effect on clinical outcome

BACKGROUND

This study aimed to identify factors affecting laparoscopic colorectal operative duration and determine the impact of prolonged operative time.

METHODS

Data were collected prospectively on all laparoscopic colorectal operations performed within 1 institution over a period of 4 years. Patients' demographics, CR-POSSUM scores, intraoperative details, surgeon experience, and postoperative outcomes were recorded and assessed in relation to operative duration.

RESULTS

Two hundred laparoscopic colorectal operations were performed (137 cancers, 63 benign). Operation duration correlated to operation type (P<0.001) and CR-POSSUM mortality risk (P = 0.03). Operative duration positively correlated with incidence of postoperative complications (P = 0.02) and length of stay (P = 0.05). Operation time >180 minutes was associated with increased incidence of postoperative complications (P = 0.006).

CONCLUSIONS

The type of laparoscopic colorectal surgical operation performed has a significantly greater impact upon operative duration than individual patient parameters, pathology, or surgical experience. Operative time is associated with a greater risk of complications and longer hospital stay.

Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss

BACKGROUND

Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in laparoscopic procedures. Nevertheless, available evidenced-based data comparing their operative results still are scarce. This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative blood losses in laparoscopic colorectal surgery.

METHODS

The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference in operating time and blood loss between instruments.

RESULTS

Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p < 0.05).

CONCLUSIONS

The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number of patients are required to confirm the results of this metaanalysis.