2005 SAGES Abstracts

POSTER ABSTRACTS
surgeons working in a community hospital, were reviewed.
Data extracted from the charts included patients’ demographics,
surgical indications and procedures, conversion rate, past
history, operative time, post-operative recovery time and complication
rates.
Results: Of the 154 patients, 70 were men. The mean age was
60. Overall, 62% of the patients had a history of prior abdominal
surgery. The majority of cases (77%) were done for benign
disease. Segmental resection involving the left colon was done
in 122 patients and right hemicolectomy in 32. The rate of conversion
to open surgery was 9,6%, and 12% for diverticulitis
(n=83). For LCR, the median operative time was 120 minutes
and median hospital stay 5 days. The complication rate was
21,6% for LCR. Mortality rate was 2,1%.
Conclusion: Outcomes of LCR done by a team of general surgeons
working together in a community hospital are similar to
historical results from academic health science centers.
P109–Colorectal/Intestinal Surgery
LAPAROSCOPIC TREATMENT OF SMALL BOWEL OBSTRUC-
TION FROM MECKEL?S DIVERTICULUM, Robert J Wilmoth
MD, Michael E Harned MD, Craig S Swafford MD,Matthew L
Mancini MD, Department of General Surgery, University of
Tennessee Medical Center, Knoxville, TN
Objective: Laparoscopy is an effective means for the evaluation
of uncertain intra-abdominal pathology. We present a
case-report utilizing laparoscopy for diagnosis and treatment
of a mechanical small bowel obstruction secondary to a
Meckel?s diverticulum.
Case Report: Patient is a 14-year-old male who initially presented
with non-specific abdominal pain, nausea, and vomiting
in December, 2003. CT scan of the abdomen and pelvis
revealed a normal appendix with a small amount of free fluid
in the pelvis. There was suggestion of mechanical small bowel
obstruction with transition zone in the pelvis. The patient was
taken to the operating room for diagnostic laparoscopy.
Results: Operative exploration revealed a large inflamed
Meckel?s diverticulum with an adhesive band to the retroperitoneum
creating an internal hernia and resultant small bowel
obstruction. The hernia was reduced laparoscopically and
intracorporeal resection of the Meckel?s was performed. The
patient improved and was discharged home on post-operative
day one.
Conclusion: Meckel?s diverticulum is the most common congenital
abnormality of the small intestine. When symptomatic,
its most common presentations are bleeding or obstruction.
Meckel?s diverticulum and its complications can be safely and
effectively managed via the laparoscopic approach.
P110–Colorectal/Intestinal Surgery
LAPAROSCOPIC SIMPLE CECECTOMY: MINIMALLY INVASIVE
THERAPY FOR CECAL POLYPS, Andrew G Harrell MD, Kent W
Kercher MD,William S Cobb MD,Michael J Rosen MD,Yuri W
Novitsky MD,Timothy S Kuwada MD,B. Todd Heniford MD,
Carolinas Medical Center
Background: Cecal cap polyps may be endoscopically unresectable
due to size or position. Previously, a right hemicolectomy,
along with its inherent risks, had been the surgical procedure
for this problem. We hypothesized that the laparoscopic
resection of the appendix and cecal cap, leaving the ileocecal
value intact, could provide safe and definitive surgical
management of cecal cap polyps without the risks of a full
colonic resection and anastomosis.
Methods: A retrospective review of all patients with endoscopically
unresectable, proximal cecal cap polyps (not involving
the ileocecal valve) who underwent a laparoscopic cecectomy
was performed. A simple cecectomy for this study was defined
as complete resection of the appendix and the cecal cap to
encompass the underlying polyp with a negative margin while
preserving the ileocecal valve. Frozen section was performed
intra-operatively to ensure complete resection and the absence
of malignancy.
Results: Thirteen patients with cecal cap polyps underwent a
laparoscopic simple cecectomy. The average age was 64 (46-
80), and four patients had moderate to severe comorbidities.
Sixty two percent (n=8) of the patients were identified on routine
screening colonoscopy. The mean operative time was 87
minutes (46 min to 184 min), including frozen section. The
average length of stay was 1.6 days (1 to 3 days). There were
no intraoperative or postoperative complications. The polyps
average size was 2.4 cm (range 1 to 4.5 cm). Two were carcinoma
in-situ, 2 had moderate to severe dysplasia, and the
remainer were villous or tubulovillous polyps. All margins
were negative. No invasive malignancy was identified in any
patient. No patients required conversion to open operation or
subsequent hemicolectomy. The average follow-up was 11.25
months (range 2 weeks to 31 months).
Conclusion: Patients that have endoscopically unresectable
polyps in the cecal cap often undergo segmental intestinal
resection. Management of large, sessile cecal polyps generally
requires either multiple endoscopic piecemeal polypectomies
or segmental intestinal resection. Laparoscopic simple cecectomy
offers patients with benign disease a minimally invasive
operation that can provide additional diagnostic and therapeutic
treatment without the morbidity or prolonged recovery of a
major intestinal resection, or the risks of repeated attempts at
endocsopic management.
P111–Colorectal/Intestinal Surgery
LAPAROSCOPIC ASSISTED PROCTOCOLECTOMY WITH ILEAL-
S-POUCH RECONSTRUCTION: IS THERE BENEFIT?, Charles P
Heise MD, Aimen Shabaan MD,Jon C Gould MD,Bruce A
Harms MD, University of Wisconsin, Madison
Introduction: Restorative Proctocolectomy has revolutionized
the surgical management of Ulcerative Colitis (UC) and
Familial Adenomatous Polyposis (FAP). This procedure has
dramatically improved the quality of life for these patients and
has evolved to include laparoscopic techniques for further
patient satisfaction. However, this approach is seldom
described for ileal-S-pouch reconstruction.
Methods: Since 1984, the University of Wisconsin Section of
Colorectal Surgery has successfully performed over 650
restorative procedures. While many centers have adopted a
double-stapled ileal-J-pouch technique, we continue to utilize
the ileal-S-pouch construction based on our experience with
its excellent capacity/compliance properties and pouch outlet
reach. This report combines the laparoscopic approach with
the S-Pouch design. We describe our technique and early
experience with laparoscopic-assisted total proctocolectomy
and ileal-S-pouch anal anastomosis (TPC + ISPAA).
Results: Review of the University of Wisconsin Colorectal
Database identified 13 laparoscopic-assisted TPC + ISPAA procedures.
These were performed in 3 males and 10 females.
Surgery was performed for UC in 11 cases and FAP in the
remaining 2 patients. A hand-assist device was utilized early in
our experience comprising 5 of the 13 procedures. There was
one conversion to open. Our current technique incorporates a
complete laparoscopic mobilization and intracorporeal colectomy
followed by minimally invasive proctectomy, ileal-S-pouch
construction and anastomosis (with or without mucosectomy).
With a mean length of 8 cm, a low vertical or transverse incision
was used for colon extraction, proctectomy and pouch
construction. In comparison to the open approach, the operative
time for the laparoscopic assisted procedure was longer
with a mean of 425 vs 339 minutes (p=0.0004). However, this
minimally invasive technique allowed for a shorter hospital
stay (mean of 5.4 vs. 7.8 days, p