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1
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Stabilini C, Garcia-Urena MA, Berrevoet F, Cuccurullo D, Capoccia Giovannini S, Dajko M, Rossi L, Decaestecker K, López Cano M. An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure. Hernia 2022; 26:411-436. [PMID: 35018560 DOI: 10.1007/s10029-021-02555-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest. METHODS Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12 months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity. RESULTS Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27-0.44) I2 0% in midline laparotomies and 0.02 (95% CI 0.00-0.07), I2 52% for off-midline. In case of LS the pooled proportion of IH for midline extraction sites were 0.10 (95% CI 0.07-0.16), I2 58% and 0.04 (95% CI 0.03-0.06), I2 86% in case of off-midline. In Port-site IH was 0.02 (95% CI 0.01-0.04), I2 82%, and for single incision surgery (SILS) of 0.06-95% CI 0.02-0.15, I2 81%. In case of stoma reversal sites was 0.20 (95% CI 0.16-0.24). CONCLUSION Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.
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Affiliation(s)
- C Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M A Garcia-Urena
- Faculty of Health Sciences, Francisco de Vitoria University, Henares University Hospital, Carretera Pozuelo-Majadahonda km 1,8, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Naples, Italy
| | - S Capoccia Giovannini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M Dajko
- Gastroenterology and Clinical Oncology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Rossi
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - M López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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2
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Feo CF, Paliogiannis P, Fancellu A, Zinellu A, Ginesu GC, Feo CV, Porcu A. Laparoscopic versus Open Transverse-Incision Approach for Right Hemicolectomy: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:80. [PMID: 33477793 PMCID: PMC7832342 DOI: 10.3390/medicina57010080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 02/05/2023]
Abstract
Background and Objectives: There is general agreement on the benefits of laparoscopy for treatment of rectal and left colon cancers, whereas findings regarding the comparison of laparoscopic and open right colonic resections are discordant. The aim of this systematic review and meta-analysis was to assess the outcomes and advantages of laparoscopic versus transverse-incision open surgery for management of right colon cancer. Materials and Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Comparative studies evaluating the results of laparoscopic and transverse-incision open right hemicolectomies were analyzed. The measured outcomes were mean operative time, time to feeding, duration of hospital stay, and number of lymph nodes harvested. Results: A total of 5 studies including 318 patients met the inclusion criteria. Meta-analysis revealed no differences in time to resume oral feeding, hospital stay, and number of lymph nodes harvested in between groups, but mean length of surgery was significantly longer in the laparoscopic group. Conclusion: These data confirm that the preferred approach to right hemicolectomy is yet unclear. Laparoscopy has a longer operative time than transverse-incision open surgery, and no significant short-term benefits were observed for the studied parameters. Well-designed randomized control trials (RCTs) might help to identify the differences between these two techniques for the surgical treatment of right colon cancer.
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Affiliation(s)
- Claudio F. Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (G.C.G.); (A.P.)
| | - Panagiotis Paliogiannis
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.Z.)
| | - Alessandro Fancellu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (G.C.G.); (A.P.)
| | - Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy; (P.P.); (A.Z.)
| | - Giorgio C. Ginesu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (G.C.G.); (A.P.)
| | - Carlo V. Feo
- Unit of General Surgery, Azienda USL di Ferrara, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy;
| | - Alberto Porcu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (A.F.); (G.C.G.); (A.P.)
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Li YS, Meng FC, Lin JK. Procedural and post-operative complications associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22431. [PMID: 33019422 PMCID: PMC7535660 DOI: 10.1097/md.0000000000022431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In this analysis, we aimed to systematically compare the procedural and post-operative complications (POC) associated with laparoscopic versus open abdominal surgery for right-sided colonic cancer resection. METHODS We searched MEDLINE, http://www.ClinicalTrials.gov, EMBASE, Web of Science, Cochrane Central, and Google scholar for English studies comparing the POC in patients who underwent laparoscopic versus open surgery (OS) for right colonic cancer. Data were assessed by the Cochrane-based RevMan 5.4 software (The Cochrane Community, London, UK). Mean difference (MD) with 95% confidence intervals (CIs) were used to represent the results for continuous variables, whereas risk ratios (RR) with 95% CIs were used for dichotomous data. RESULTS Twenty-six studies involving a total number of 3410 participants with right colonic carcinoma were included in this analysis. One thousand five hundred and fifteen participants were assigned to undergo invasive laparoscopic surgery whereas 1895 participants were assigned to the open abdominal surgery. Our results showed that the open resection was associated with a shorter length of surgery (MD: 48.63, 95% CI: 30.15-67.12; P = .00001) whereas laparoscopic intervention was associated with a shorter hospital stay [MD (-3.09), 95% CI [-5.82 to (-0.37)]; P = .03]. In addition, POC such as anastomotic leak (RR: 0.96, 95% CI: 0.60-1.55; P = .88), abdominal abscess (RR: 1.13, 95% CI: 0.52-2.49; P = .75), pulmonary embolism (RR: 0.40, 95% CI: 0.09-1.69; P = .21) and deep vein thrombosis (RR: 0.94, 95% CI: 0.39-2.28; P = .89) were not significantly different. Paralytic ileus (RR: 0.87, 95% CI: 0.67-1.11; P = .26), intra-abdominal infection (RR: 0.82, 95% CI: 0.15-4.48; P = .82), pulmonary complications (RR: 0.83, 95% CI: 0.57-1.20; P = .32), cardiac complications (RR: 0.73, 95% CI: 0.42-1.27; P = .27) and urological complications (RR: 0.83, 95% CI: 0.52-1.33; P = .44) were also similarly manifested. Our analysis also showed 30-day re-admission and re-operation, and mortality to be similar between laparoscopic versus OS for right colonic carcinoma resection. However, surgical wound infection (RR: 0.65, 95% CI: 0.50-0.86; P = .002) was significantly higher with the OS. CONCLUSIONS In conclusion, laparoscopic surgery was almost comparable to OS in terms of post-operative outcomes for right-sided colonic cancer resection and was not associated with higher unwanted outcomes. Therefore, laparoscopic intervention should be considered as safe as the open abdominal surgery for right-sided colonic cancer resection, with a decreased hospital stay.
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Affiliation(s)
| | | | - Jun Kai Lin
- Department of Gastroenterology, Dongying Shengli Oilfield Central Hospital, Dongying, Shandong, P.R. China
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4
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Feo CF, Feo CV, Fancellu A, Ginesu GC, Cherchi G, Zese M, Targa S, Porcu A. Laparoscopic versus open transverse-incision right hemicolectomy: a retrospective comparison study. ANZ J Surg 2019; 89:E292-E296. [PMID: 31066197 DOI: 10.1111/ans.15166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/26/2019] [Accepted: 03/03/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND The optimal surgical approach to right colon cancer is still under debate. The aim of the present study was to compare the short- and long-term outcomes of laparoscopic and transverse-incision open approaches to right hemicolectomy for colon cancer. METHODS Data on 99 adult patients with right-side colon cancer undergoing either laparoscopic or open transverse-incision right hemicolectomy at two different university hospitals, between January 2013 and December 2016, were retrospectively reviewed. Data concerning patients' characteristics, operative details and post-operative recovery were retrieved from prospective databases and analysed. RESULTS Forty-nine subjects were operated on laparoscopically, while 50 through an open transverse incision. Operating time was significantly longer in the laparoscopic group compared with the open group (182 versus 105 min; P < 0.01). Patients treated laparoscopically had a shorter time to first bowel movement, while time to resume a normal diet and post-operative length of hospital stay were comparable in between groups. The median number of lymph nodes harvested was higher in the laparoscopic group (25.6 versus 18.6; P < 0.01), but no significant difference in overall survival between groups was detected. At long-term follow-up, the incidence of incisional hernia was higher in the laparoscopic group as compared to the open group (24.5% versus 0%; P = 0.0002). CONCLUSION Our results show that laparoscopic right hemicolectomy when compared to the transverse-incision open procedure may guarantee the same oncological radicality, but short-term functional benefits are still unclear. Randomized control studies are warranted to better clarify the comparison of these two approaches for right-sided colon cancers.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Carlo V Feo
- Unit of General Surgery, Azienda USL di Ferrara and Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alessandro Fancellu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giorgio C Ginesu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Cherchi
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Monica Zese
- Unit of General Surgery, Azienda USL di Ferrara and Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Simone Targa
- Unit of General Surgery, Azienda USL di Ferrara and Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Alberto Porcu
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Jurowich C, Lichthardt S, Matthes N, Kastner C, Haubitz I, Prock A, Filser J, Löb S, Germer CT, Wiegering A. Comparison of conventional access routes for right hemicolectomy in colon cancer-data from the DGAV StuDoQ registry. Int J Colorectal Dis 2019; 34:161-167. [PMID: 30392039 DOI: 10.1007/s00384-018-3188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Access for right hemicolectomy can be gained by median or transverse incision laparotomy. It is not known whether these routes differ with regard to short-term postoperative outcomes. METHODS Patients in the DGAV StuDoQ|ColonCancer registry who underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) were compared regarding Clavien-Dindo classification (CDC) complications (primary endpoint) as well as specific postoperative complications, operation time, length of stay, and MTL30 status (secondary endpoints). RESULTS A total of 3700 StuDoQ registry patients underwent open oncological right hemicolectomy by median (n = 2389) or transverse laparotomy (n = 1311) without additional interventions. The median and transverse access routes did not differ regarding CDC complication rates (CDC > =3a: 13.1% vs. 12.6%; p = 0.90). However, univariate and multivariate analyses showed that operation times (OR 0.71, 95% CI 0.62-0.81; p < 0.001), length of stay (OR 0.69, 95% CI 0.6-079; p < 0.001), and MTL30 (OR 0.7, 95% CI 0.61-0.81, p < 0.001) were significantly reduced in the transverse laparotomy group. CONCLUSIONS For oncological right hemicolectomy, open transverse upper abdominal laparotomy appears to be superior to median laparotomy in short-term course.
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Affiliation(s)
- Christian Jurowich
- Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altötting / Burghausen, Vinzenz-von-Paul-Str. 10, 84503, Altötting, Germany
| | - Sven Lichthardt
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany
| | - Niels Matthes
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany
| | - Caroline Kastner
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany
| | - Imme Haubitz
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany
| | - Andre Prock
- Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altötting / Burghausen, Vinzenz-von-Paul-Str. 10, 84503, Altötting, Germany
| | - Jörg Filser
- Department of General, Visceral and Thoracic Surgery, Kreiskliniken Altötting / Burghausen, Vinzenz-von-Paul-Str. 10, 84503, Altötting, Germany
| | - Stefan Löb
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. 6, 97080, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany.,Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. 6, 97080, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. 2, 97080, Würzburg, Germany. .,Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. 6, 97080, Würzburg, Germany. .,Department of Biochemistry and Molecular Biology, University of Wuerzburg, Würzburg, Germany.
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Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach. Surg Endosc 2018; 33:1020-1032. [PMID: 30456506 DOI: 10.1007/s00464-018-6592-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are a variety of surgical approaches for the management of right-sided colonic neoplasms. To date, no method has been shown superior in terms of surgical and perioperative outcomes. This meta-analysis compared open (ORH), laparoscopic-assisted (LRH), total laparoscopic (TLRH), and robotic right hemicolectomy (RRH) to assess surgical outcomes and perioperative morbidity and mortality. STUDY DESIGN We conducted an electronic systematic search using PubMed, EMBASE, and Web of Science that compared RRH, TLRH, LRH, and ORH. Forty-eight studies met the inclusion criteria: 5 randomized controlled trials, 25 retrospective, and 18 prospective studies totalling 5652 patients were included. RESULTS The overall complication rate was similar between RRH and TLRH (RR 1.0; Crl 0.66-1.5). The anastomotic leak rate was higher in LRH and ORH compared to RRH (RR 1.9; Crl 0.99-3.6 and RR 1.2; Crl 0.55-2.6, respectively), whereas it was lower in TLRH compared to RRH (RR 0.88 Crl 0.41-1.9). The risk of reoperation was significantly higher in ORH compared to TLRH (RR 3.3; Crl 1.3-8.0). Operative time was similar in RRH compared to LRH (RR - 27.0; Crl - 61.0 to 5.9), and to TLRH (RR - 24.0; Crl - 70.0 to 21.0). The hospital stay was significantly longer in LRH compared to RRH (RR 3.7; Crl 0.7-6.7). CONCLUSION The surgical management of right-sided colonic disease is evolving. This network meta-analysis observed that short-term outcomes following RRH and TLRH were superior to standard LRH and ORH. The adoption of more advanced minimally invasive techniques can be costly and have associated learning phases, but will ultimately improve patient outcomes.
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Modified Pfannenstiel Open Approach as an Alternative to Laparoscopic Total Proctocolectomy and IPAA: Comparison of Short- and Long-term Outcomes and Quality of Life. Dis Colon Rectum 2018; 61:573-578. [PMID: 29630002 DOI: 10.1097/dcr.0000000000001052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND A laparoscopic approach to total proctocolectomy with IPAA has been suggested to have better short-term outcomes and cosmesis, whereas open surgery by midline incision may result in shorter operative times. We hypothesized that a modified Pfannenstiel open approach would combine the advantages of both techniques. OBJECTIVE The purpose of this study was to compare outcomes of open total proctocolectomy with IPAA using a modified Pfannenstiel incision versus those following the laparoscopic approach. DESIGN This was a retrospective study comparing patients submitted to open IPAA using modified Pfannenstiel incision versus laparoscopy from 1998 to 2014. SETTINGS The study was conducted at a high-volume tertiary referral center. PATIENTS Among 1275 patients, 119 patients underwent the laparoscopic approach and 33 underwent the modified Pfannenstiel approach. MAIN OUTCOME MEASURES Short- and long-term outcomes were evaluated, and quality-of-life questionnaires were assessed. RESULTS Patients who underwent the modified Pfannenstiel approach were younger, more often women, and had lower BMI and ASA classification compared with those who underwent laparoscopy. Surgical time was lower in Pfannenstiel, and no difference was observed in length of hospital stay. No difference was observed in postoperative complications, pouch failure rate, or quality of life. Patients were then matched 1:1 by diagnosis, sex, age (±5 y) and BMI (±5 kg/m). The Pfannenstiel approach still had a shorter surgical time. No difference was observed in the length of hospital stay, complications, pouch failure, or quality of life. In long-term follow-up, pouchitis symptoms occurred more frequently in Pfannenstiel (mean follow-up = 7.3 y), and seepage was more frequently observed in the laparoscopy group (mean follow-up = 4.2 y). These differences were not observed in matched patients. LIMITATIONS The study was limited by its retrospective design and inherent selection bias. CONCLUSIONS The modified Pfannenstiel approach provides equivalent short- and long-term outcomes and similar quality of life compared with laparoscopy but with a significantly shorter operative time. The modified Pfannenstiel approach to total proctocolectomy with IPAA may be the most efficient method in selected patients. See Video Abstract at http://links.lww.com/DCR/A562.
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Bosker RJI, Van't Riet E, de Noo M, Vermaas M, Karsten TM, Pierie JP. Minimally Invasive versus Open Approach for Right-Sided Colectomy: A Study in 12,006 Patients from the Dutch Surgical Colorectal Audit. Dig Surg 2018; 36:27-32. [PMID: 29414813 DOI: 10.1159/000486400] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/19/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is ongoing debate whether laparoscopic right colectomy is superior to open surgery. The purpose of this study was to address this issue and arrive at a consensus using data from a national database. METHODS Patients who underwent elective open or laparoscopic right colectomy for colorectal cancer during the period 2009-2013 were identified from the Dutch Surgical Colorectal Audit. Complications that occurred within 30 days after surgery and 30-day mortality rates were calculated and compared between open and laparoscopic resection. RESULTS In total, 12,006 patients underwent elective open or laparoscopic surgery for right-sided colorectal cancer. Of these, 6,683 (55.7%) underwent open resection and 5,323 (44.3%) underwent laparoscopic resection. Complications occurred within 30 days after surgery in the laparoscopic group in 26.1% of patients and in 32.1% of patients in the open group (p < 0.001). Thirty-day mortality was also significantly lower in the laparoscopic group (2.2 vs. 3.6% p < 0.001). CONCLUSION In this non-randomized, descriptive study conducted in the Netherlands, open right colectomy seems to have a higher risk for complications and mortality as compared to laparoscopic right colectomy, even after correction for confounding factors.
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Affiliation(s)
| | - Esther Van't Riet
- Department of Epidemiology, Deventer Hospital, Deventer, The Netherlands
| | - Mirre de Noo
- Department of Surgery, Deventer Hospital, Deventer, The Netherlands
| | - Maarten Vermaas
- Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Tom M Karsten
- Department of Surgery, Onze Lieve Vrouwen Gasthuis, Amsterdam, The Netherlands
| | - Jean-Pierre Pierie
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden Institute for Minimally Invasive Surgery (LIMIS), Leeuwarden, The Netherlands.,Postgraduate School of Medicine University Medical Center Groningen and University Groningen, Groningen, The Netherlands
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9
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Fabozzi M, Cirillo P, Corcione F. Surgical approach to right colon cancer: From open technique to robot. State of art. World J Gastrointest Surg 2016; 8:564-573. [PMID: 27648160 PMCID: PMC5003935 DOI: 10.4240/wjgs.v8.i8.564] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 02/06/2023] Open
Abstract
This work is a topic highlight on the surgical treatment of the right colon pathologies, focusing on the literature state of art and comparing the open surgery to the different laparoscopic and robotic procedures. Different laparoscopic procedures have been described for the treatment of right colon tumors: Totally laparoscopic right colectomy, laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy, single incision laparoscopic surgery colectomy, robotic right colectomy. Two main characteristics of these techniques are the different type of anastomosis: Intracorporeal (for totally laparoscopic right colectomy, single incision laparoscopic surgery colectomy, laparoscopic assisted right colectomy and robotic technique) or extracorporeal (for laparoscopic assisted right colectomy, laparoscopic facilitated right colectomy, hand-assisted right colectomy and open right colectomy) and the different incision (suprapubic, median or transverse on the right side of abdomen). The different laparoscopic techniques meet the same oncological criteria of radicalism as the open surgery for the right colon. The totally laparoscopic right colectomy with intracorporeal anastomosis and even more the single incision laparoscopic surgery colectomy, remain a technical challenge due to the complexity of procedures (especially for the single incision laparoscopic surgery colectomy) and the particular right colon vascular anatomy but they seem to have some theoretical advantages compared to the other laparoscopic and open procedures. Data reported in literature while confirming the advantages of laparoscopic approach, do not allow to solve controversies about which is the best laparoscopic technique (Intracorporeal vs Extracorporeal Anastomosis) to treat the right colon cancer. However, the laparoscopic techniques with intracorporeal anastomosis for the right colon seem to show some theoretical advantages (functional, technical, oncological and cosmetic advantages) even if all studies conclude that further prospective randomized trials are necessary. Robotic technique may be useful to overcome the problems related to inexperience in laparoscopy in some surgical centers.
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10
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Lorenzon L, Montebelli F, Mercantini P, Sebastiani S, Ziparo V, Ferri M. Right Colectomy for Cancer: A Matched Comparison of Three Different Surgical Approaches. J INVEST SURG 2016; 29:405-412. [PMID: 27282341 DOI: 10.1080/08941939.2016.1183735] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Laura Lorenzon
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Francesco Montebelli
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Paolo Mercantini
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Simone Sebastiani
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Vincenzo Ziparo
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
| | - Mario Ferri
- Surgical and Medical Department of Translational Medicine, University of Rome “La Sapienza”, St. Andrea Hospital, Rome, Italy
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11
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Widdison AL, Barns V, Prescott O, Pollard A. A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer. Ann Med Surg (Lond) 2016; 5:23-8. [PMID: 26835008 PMCID: PMC4700193 DOI: 10.1016/j.amsu.2015.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 11/13/2015] [Accepted: 11/14/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The morbidity, mortality and survival following a laparoscopic right hemicolectomy for colon cancer are equivalent to an open operation. However, the cost of a longer operating time and consumables may offset savings from a shorter length of stay (LOS). A cost minimization study was undertaken to compare the relative costs. METHODS A retrospective cohort study of consecutive elective right hemicolectomies for colon cancer performed over 5 years by two teams. One team performed an open operation (OG), the other intended to perform all operations laparoscopically (LG). Clinical outcomes and relative costs were evaluated. Results expressed as mean ± SEM. RESULTS There were 58 patients in the open group and 56 in the first intention laparoscopic group, of which 77% were completed laparoscopically. There was no difference in age, gender or cancer stage. The complications, mortality and 5-year survival were similar. Anaesthetic (LG = 63 ± 3, OG = 62 ± 2 min) and surgical times (LG = 144 ± 8, OG = 143 ± 5 min) were similar. Consumables cost €571 more and the total theatre cost was €643 ± 256 higher in the laparoscopic group compared with the open group (p = 0.01). The LOS in the laparoscopic group (4.6 ± 0.5 days) was less than in the open group (8.3 ± 1 days, p < 0.01) saving €1960 ± 636 per patient. Overall, first intention laparoscopic right hemicolectomies saved €1316 ± 733 per patient. A probability sensitivity analysis indicated a 62% probability that a laparoscopic right hemicolectomy was cheaper than an open operation. CONCLUSION Laparoscopic right hemicolectomy is oncologically equivalent but less costly and should be considered the procedure of choice for right-sided colon cancer unless contraindicated.
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Affiliation(s)
- Adam L. Widdison
- Department of Surgery, Royal Cornwall Hospital NHS Trust, England, United Kingdom
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Guida F, Clemente M, Valvano L, Napolitano C. Laparoscopic or open hemicolectomy for elderly patients with right colon cancer? A retrospective analysis. G Chir 2015; 36:205-8. [PMID: 26712256 DOI: 10.11138/gchir/2015.36.5.205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIM The aim of this study was to compare the short-term surgical outcomes of laparoscopically-assisted right hemicolectomy (LRH) and open right hemicolectomy (ORH) in elderly patients. Patients and methods-Results. Seventy-five patients underwent right hemicolectomy for cancer during the study period, with 41 patients aged ≥ 70 years old. Twenty-four patients underwent ORH and seventeen patients had a LRH (58% vs 42%).We found no differences between ORH and LRH in terms of mean operative time :89,5 minutes in open vs 80 minutes in laparoscopic group and return of bowel function (2,76 vs 2,54 days). Also the length of hospital stay did not differ significantly between the two groups (8,5 days in ORH vs 7 days in LRH - p 0,06). Postoperative morbidity was higher in ORH (25% vs 5%) though not statistically significant and the incidence of anastomotic leakage was similar between the two groups (8% vs 5%). CONCLUSION Laparoscopic RH in an elderly population is feasible and safe. However, we found no evidence to suggest that it is better than open RH and think that the decision regarding the method of operation should reflect surgeon expertise, patient co-morbidities and the necessity to perform extended resections.
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Arezzo A, Passera R, Ferri V, Gonella F, Cirocchi R, Morino M. Laparoscopic right colectomy reduces short-term mortality and morbidity. Results of a systematic review and meta-analysis. Int J Colorectal Dis 2015; 30:1457-72. [PMID: 26137968 DOI: 10.1007/s00384-015-2304-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE While definitive long-term results are not yet available, the global safety and oncologic adequacy of laparoscopic surgery for right colectomy remain controversial. The aim of the study was to evaluate differences in safety of laparoscopic right colectomy, compared with open surgery, with particular attention to cancer patients. METHODS A systematic review from 1991 to 2014 was performed searching the MEDLINE and EMBASE databases (PROSPERO Registration number: CRD42014015256). We included randomised and controlled clinical studies comparing laparoscopic and open resection for rectal cancer. Primary endpoints were 30 days mortality and overall morbidity. Then, a meta-analysis was conducted by a fixed-effect model, performing a sensitivity analysis by a random-effect model. Relative risk (RR) was used as an indicator of treatment effect; a RR less than 1.0 was in favour of laparoscopy. Publication bias was assessed by funnel plot, heterogeneity by the I (2) test and subgroup analysis on oncologic patients. RESULTS Twenty-seven studies, representing 3049 patients, met the inclusion criteria; only 2 were randomised for a total of 211 patients. Mortality was observed in 1.2 % of patients in the laparoscopic group and in 3.4 % of patients in the open group. The overall RR was 0.45 (95 % CI 0.21-0.93, p = 0.031). The raw incidence of overall complications was significantly lower in the laparoscopic group (16.8 %) compared to the open group (24.2 %). The overall RR was 0.81 (95 % CI 0.70-0.95, p = 0.007). CONCLUSIONS Based on the evidence of few randomised and mostly controlled series, mortality and morbidity were significantly lower after laparoscopy compared to open surgery.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Valentina Ferri
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Federica Gonella
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, Terni, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
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Lorenzon L, La Torre M, Ziparo V, Montebelli F, Mercantini P, Balducci G, Ferri M. Evidence based medicine and surgical approaches for colon cancer: Evidences, benefits and limitations of the laparoscopic vs open resection. World J Gastroenterol 2014; 20:3680-3692. [PMID: 24707154 PMCID: PMC3974538 DOI: 10.3748/wjg.v20.i13.3680] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/26/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To report a meta-analysis of the studies that compared the laparoscopic with the open approach for colon cancer resection.
METHODS: Forty-seven manuscripts were reviewed, 33 of which employed for meta-analysis according to the PRISMA guidelines. The results were differentiated according to the study design (prospective randomized trials vs case-control series) and according to the tumor’s location. Outcome measures included: (1) short-term results (operating times, blood losses, bowel function recovery, post-operative pain, return to the oral intake, complications and hospital stay); (2) oncological adequateness (number of nodes harvested in the surgical specimens); and (3) long-term results (including the survivals’ rates and incidence of incisional hernias) and (4) costs.
RESULTS: Meta-analysis of trials provided evidences in support of the laparoscopic procedures for a several short-term outcomes including: a lower blood loss, an earlier recovery of the bowel function, an earlier return to the oral intake, a shorter hospital stay and a lower morbidity rate. Opposite the operating time has been confirmed shorter in open surgery. The same trend has been reported investigating case-control series and cancer by sites, even though there are some concerns regarding the power of the studies in this latter field due to the small number of trials and the small sample of patients enrolled. The two approaches were comparable regarding the mean number of nodes harvested and long-term results, even though these variables were documented reviewing the literature but were not computable for meta-analysis. The analysis of the costs documented lower costs for the open surgery, however just few studies investigated the incidence of post-operative hernias.
CONCLUSION: Laparoscopy is superior for the majority of short-term results. Future studies should better differentiate these approaches on the basis of tumors’ location and the post-operative hernias.
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Santoro A, Boselli C, Renzi C, Gubbiotti F, Grassi V, Di Rocco G, Cirocchi R, Redler A. Transverse skin crease versus vertical midline incision versus laparoscopy for right hemicolectomy: a systematic review--current status of right hemicolectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:643685. [PMID: 24605333 PMCID: PMC3925523 DOI: 10.1155/2014/643685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE The right hemicolectomy may be conducted through laparoscopic or laparotomic surgery, transverse or midline incisions. The transverse laparotomy offers some advantages compared to the midline laparotomy and laparoscopy. A literature review was performed to evaluate the possible advantages of the transverse incision versus midline incision or laparoscopic right hemicolectomy. METHODS A systematic research was performed in Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, and the Science Citation Index. RESULTS Laparotomic right hemicolectomy with transverse incision is preferable to laparotomic hemicolectomy with midline incision. A transverse incision offers a lessened postoperative pain following physical activity, a lessened need to administer analgesic therapy during the post-operative time, better aesthetic results, and a better post-operative pulmonary function. Open surgery with transverse or midline incision ensured a shorter operative time, lower costs and a greater length of the incision compared to the laparoscopic. However, there are no differences in the oncological outcomes. CONCLUSIONS It was not possible to identify significant differences between the open right hemicolectomy with transverse incision versus the open right hemicolectomy with midline incision or laparoscopic hemicolectomy.
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Affiliation(s)
- Alberto Santoro
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00185 Rome, Italy
| | - Carlo Boselli
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Località Sant'Andrea delle Fratte, Via Gambuli 1, 06156 Perugia, Italy
| | - Claudio Renzi
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Località Sant'Andrea delle Fratte, Via Gambuli 1, 06156 Perugia, Italy
| | - Francesca Gubbiotti
- Department of General Surgery, University of Ferrara, Via Fossato di Mortara 64/A, 44121 Ferrara, Italy
| | - Veronica Grassi
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Località Sant'Andrea delle Fratte, Via Gambuli 1, 06156 Perugia, Italy
| | - Giorgio Di Rocco
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00185 Rome, Italy
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Località Sant'Andrea delle Fratte, Via Gambuli 1, 06156 Perugia, Italy
| | - Adriano Redler
- Department of Surgical Sciences, “Sapienza” University of Rome, Viale Regina Elena 324, 00185 Rome, Italy
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Ferri M, Rossi Del Monte S, Salerno G, Bocchetti T, Angeletti S, Malisan F, Cardelli P, Ziparo V, Torrisi MR, Visco V. Recovery of immunological homeostasis positively correlates both with early stages of right-colorectal cancer and laparoscopic surgery. PLoS One 2013; 8:e74455. [PMID: 24040252 PMCID: PMC3767741 DOI: 10.1371/journal.pone.0074455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 08/01/2013] [Indexed: 12/18/2022] Open
Abstract
Differences in postoperative outcome and recovery between patients subjected to laparoscopic-assisted versus open surgery for colorectal cancer (CRC) resection have been widely documented, though not specifically for right-sided tumors. We investigated the immunological responses to the different surgical approaches, by comparing postoperative data simultaneously obtained at systemic, local and cellular levels. A total of 25 right-sided CRC patients and controls were managed, assessing -in the immediate followup- the conventional perioperative parameters and a large panel of cytokines on plasma, peritoneal fluids and lipopolysaccharide (LPS)-stimulated peripheral blood mononuclear cells (PBMC) tissue cultures. A general better recovery for patients operated with laparoscopy compared to conventional procedure, as indicated by the analysis of typical pre- and post-surgical parameters, was observed. The synchronous evaluation of 12 cytokines showed that preoperative plasma levels of the proinflammatory cytokines IL-6, IL-8, IL-1β, TNFα were significantly lower in healthy donors versus CRC patients and that such differences progressively increase with tumor stage. After surgery, the IL-6 and IL-8 increases were significantly higher in open compared to laparoscopic approach only in CRC at early stages. The postsurgical whole panel of cytokine levels were significantly higher in peritoneal fluids compared to corresponding plasma, but with no significant differences depending on kind of surgery or stage of disease. Then we observed that, pre- compared to the corresponding post-surgery derived LPS-stimulated PBMC cultures, produced higher supernatant levels of the whole cytokine panel. In particular IL-6 in vitro production was significantly higher in PBMC derived from patients subjected to laparoscopic versus open intervention, but -again- only in CRC at early stages of disease. Our results thus show that laparoscopy compared to open right resection is associated with a shorter compromission of the immunological homeostasis, mainly in early stages of right-CRC patients.
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Affiliation(s)
- Mario Ferri
- Surgical and Medical Department of the Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Simone Rossi Del Monte
- Surgical and Medical Department of the Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Gerardo Salerno
- Department of Clinical and Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Tommaso Bocchetti
- Surgical and Medical Department of the Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Stefano Angeletti
- Surgical and Medical Department of the Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Florence Malisan
- Laboratory of Immunology and Signal Transduction, University of Rome ‘Tor Vergata’, Rome, Italy
| | - Patrizia Cardelli
- Department of Clinical and Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Vincenzo Ziparo
- Surgical and Medical Department of the Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Maria Rosaria Torrisi
- Department of Clinical and Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Istituto Pasteur-Fondazione Cenci Bolognetti, Faculty of Medicine and Psychology University of Rome “Sapienza”, Rome, Italy
- Sant’Andrea Hospital, Rome, Italy
- * E-mail:
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Quyn AJ, Moussa O, Millar F, Smith DM, Steele RJC. Open versus laparoscopic right hemicolectomy in the elderly population. World J Gastrointest Surg 2013; 5:187-191. [PMID: 23805362 PMCID: PMC3692954 DOI: 10.4240/wjgs.v5.i6.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 05/16/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare short term outcomes of elective laparoscopic and open right hemicolectomy (RH) in an elderly population.
METHODS: All patients over the age of 70 undergoing elective RH at Ninewells Hospital and Perth Royal Infirmary between January 2006 and May 2011 were included in our analysis. Operative details, hospital length of stay, morbidity and mortality was collected by way of proforma from a dedicated prospective database. An extracorporeal anastomosis was performed routinely in the laparoscopic group. The primary endpoints for analysis were morbidity and mortality. Our secondary endpoints were operative duration, length of hospital stay and discharge destination.
RESULTS: Two hundred and six patients were included in our analysis. One hundred and twenty-five patients underwent an open resection and 81 patients had a laparoscopic resection. The mean operating time was significantly longer in the laparoscopic group (139 ±
36 min vs 197 ± 53 min, P = 0.001). The mean length of hospital stay was similar in both groups (11.2 ± 7.8 d vs 9.6 ± 10.7 d, P = 0.28). The incidence of post-operative morbidities was 27% in the open group and 38% in the laparoscopic group (P = 0.12). Overall in-hospital mortality was 0.8% in open procedures vs 1% in laparoscopic.
CONCLUSION: Laparoscopic RH was associated with a significantly longer operative time compared to open RH. In our study, laparoscopic RH was not associated with reduced post-operative morbidity or significantly shorter length of hospital stay.
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Abstract
UNLABELLED The role of laparoscopy for right colectomy remains controversial - largely because of a lack of standardization of the operative procedure, including a diversity of techniques including laparoscopy-assisted cases with extra-corporeal anastomosis and totally laparoscopic procedures with intra-corporeal anastomosis. METHODS The charts of all patients who underwent right colectomy by a totally laparoscopic approach in our service since 2004 were reviewed and pre-, intra-, and postoperative data were collected. RESULTS Eighty-two patients underwent totally laparoscopic right colectomy; of these, 32 had a BMI greater than 20 kg/m2 (39%). The mean operative duration was 113 minutes. In most cases, the operative specimen was extracted through a supra-pubic Pfannenstiel incision measuring 4-6 cm in length. Three cases were converted to a laparoscopy-assisted technique (in order to control the ileo-cecal vascular pedicle because of extensive nodal invasion in two cases, and to evaluate a hepatic flexure polyp in the third case). Overall morbidity was 29.3% and parietal morbidity was only 9.8%; there was no difference in morbidity between obese patients (BMI>30 kg/m2) and non-obese patients (BMI<30 kg/m2). The mean duration of hospitalization was 9 days and two patients developed ventral hernia in the extraction incision in long-term follow-up. CONCLUSION These satisfactory results show that the totally laparoscopic approach to right colectomy is technically feasible and safe, even in obese patients. In addition, the very low rate of parietal complications is an argument in favor of this approach.
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