2005 SAGES Abstracts

POSTER ABSTRACTS
RESULTS: The mean age was 56 years (range, 28-84). Primary
complaints were transanal protrusion (16), impaired fecal
extrusion (13) and fecal incontinence (3). Preoperative assessment
included clinical examination, selective imaging including
barium enema, defecography, colonoscopy and transit
studies. Twenty five pts (78%) had sigmoidectomy with dissection
rectopexy, 5 pts (16%) had a left colectomy with rectopexy,
and 2 pts (6%) had total abdominal colectomy and rectopexy.
There were no conversions to open. Mean estimated
blood loss was 205 (range, 50-800) cc. No pt needed blood
transfusion. Mean number of incisions was 3.5 (range, 3-5).
Mean length of largest incision was 4 (range, 3-6.1) cm. There
was no mortality. Complications noted in 4 pts (12%): two
developed small bowel obstruction, one requiring surgery; one
instance of minor incisional bleeding and one urinary tract
infection. Mean follow-up was 15.3 (4-52) months. Mean postoperative
hospitalization was 4.5 (range, 2-8) days. Two (6%)
pts developed full thickness recurrence: one in 10 months and
another in 18 months after surgery, both of which were
repaired by a Delorme procedure without recurrence. Pts with
fecal extrusion impairment required a transanal mucosal excision,
in 7/16 pts, all successfully treated. Twenty pts (62.5%)
had complete resolution and 12 (37.5%) while improved had
minor residual functional complaints.
CONCLUSION: Colectomy with rectopexy for CRP or HRP can
be safely performed laparoscopically with low morbidity and
acceptable functional outcome. As in open surgery mucosal
redundancy with fecal extrusion difficulty is a frequent sequel
to anterior resection and rectopexy for HRP and transanal
mucosal excision should be planned with anticipation of satisfactory
results. Long term follow up studies are needed to
properly assess the recurrence rates.
P101–Colorectal/Intestinal Surgery
SAME DAY DISCHARGE AFTER LAPAROSCOPIC COLON
RESECTION, Mehran Anvari PhD, Allan Okrainec MD,Cliff
Sample MD,Herawaty Sebajang MD,Ann Brannigan MD,
Centre for Minimal Access Surgery, McMaster University,
Hamilton, Ontario, Canada
Laparoscopic colon resection has been associated with
reduced length of stay. We have initiated a program of discharging
patients within the same day (24 hours) after laparoscopic
colon resection and with a pain pump to provide local
analgesic control to the extraction excision site.
5 patients with a mean age of 65.4 (range 44-83) underwent
laparoscopic colon resection (3 Right Hemicolectomy for cancer,
1 Anterior Resection for cancer, 1 sigmoid resection with
stomal closure). The mean OR time was 131±9 mins and the
median ASA Score was 3 (range 2-4). The mean time to discharge
was 20.6±0.7 hours. Prior to discharge, 2 patients
required oral narcotics for abdominal pain. There were no
peri-operative complications and all patients were satisfied
with early discharge and had unremarkable recoveries.
Conclusion: Same day discharge after laparoscopic colectomy
is safe and feasible in select patients with good home support.
Use of a local pain pump helps reduce the need for post-operative
narcotics.
P102–Colorectal/Intestinal Surgery
LAPAROSCOPY HAS A PLACE IN THE REVERSAL OF HART-
MANN PROCEDURE, George Bouras MD, Maria Mara Arenas
Sanchez, MD,Harutaka Inoue MD,Joel Leroy MD,Francesco
Rubino MD,Didier Mutter PhD,Antonello Forgione MD,Jacques
Marescaux MD, IRCAD/EITS, University Hospital of Strasbourg,
France
Background: It has been suggested that laparoscopic reversal
of Hartmann procedure (LRHP) is associated with less patient
morbidity and shorter hospital stay compared to open surgery.
The aim of this study was to evaluate the outcomes of LRHP in
order to assess whether such advantages are conveyed in our
experience.
Methods: A retrospective analysis of all patients who underwent
reversal of Hartmann procedure between August 1998
and August 2004 was performed. Data collection included preoperative
(age, sex, ASA score, BMI, diagnosis, interval to
reversal), intra-operative (operative time, intra-operative findings,
conversion) and post-operative (morbidity, mortality, hospital
stay, follow-up) data.
Results: Reversal of Hartmann procedure was performed in 36
patients. Twenty-two cases were performed by laparoscopy
and 14 cases were performed by open surgery. There was no
significant difference between laparoscopic and open groups
in terms of age, sex, ASA score, BMI, diagnosis, follow-up and
time to reversal. For the laparoscopic group, the male to
female ratio was 13:9, mean age was 59.6 years (range 40-82),
mean ASA score was 2.09 (range 2-3), mean BMI was 26.1
kg/m2 (range 21.2-33.1), mean interval to reversal was 5.8
months (range 1-13), and mean follow-up was 10.1 months
(range 1-72). The mean BMI was lower for the laparoscopic
group compared to the open group (26.1 vs 29.1 kg/m2,
p=NS). Laparoscopic RHP was completed in 21/22 patients
(conversion rate 4.5%), the only conversion being due to due
to severe adhesions. Compared to open surgery, the mean
operative time was less (174 vs 223 minutes, p