2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
ileostomy or bowel exploration was performed, mostly for
perianal disease. In 13 uncomplicated cases, ileocecal resection,
hemicolectomy or ileal resection was carried out, eventually
combined with strictureplasties or appendectomy. In 20
patients, there was recurrent disease (8) and/or complications
had occurred as ileus, sealed perforations, abscess formations
(4) and fistulas (10) to other organs.
RESULTS: In the 13 uncomplicated cases, median operative
time was 195 min (120-250). The median length of hospital
stay was 8 days (6-27). There was one postoperative anastomotic
leak demanding reoperation in a patient who had been
treated by high-dosage immunosuppressives. In the 20 complicated
cases, the small bowel was explored completely after
adhesiolysis. In 13 cases, small and large bowel was resected,
in 4 of these with extended segments of ileum or colon. In 5
cases, two separate segments of ileum and colon were resected.
In 2 cases of recurrent Crohn’s disease, only small bowel
was resected, in one of them with 6 additional strictureplasties.
There were no intraoperative complications and no reoperations.
The median length of hospital stay was 9 days (6-18).
CONCLUSIONS: Even complicated cases of Crohn’s disease
with previous surgery, fistulas, abscesses and sealed perforations
may be treated safely by laparoscopic technique.
P113–Colorectal/Intestinal Surgery
THREE TROCAR TECHNIQUE FOR LAPAROSCOPIC-ASSISTED
REVERSAL OF HARTMANN’S PROCEDURE, Matthew K Kissner
MD, Abdelkader Hawasli MD,Ahmed A Meguid MD,
Department of Minimally Invasive Surgery, St. John Hospital
and Medical Center, Detroit, MI
Introduction: The aim of this study was to examine the feasibility
and results of the laparoscopic approach to Hartmann’s
reversal as compared to the open technique. Reversal of
Hartmann’s procedures has historically been associated with a
high risk of morbidity and mortality. In addition, open reversals
are associated with hospital stays nearing that of the initial
procedure with even longer operative times.
Methods: This study was a prospective review of 4 patients
who had undergone Hartmann’s procedure for various
pathologies. All 4 patients underwent laparoscopic-assisted
reversal of Hartmann’s procedure by one surgeon in a community
hospital setting. This was done using a technique that
employed three 5 mm trocars. This group of patients was subsequently
compared to a cohort of patients who had undergone
open reversal of colostomies at the same institution during
the previous 3 years.
Results: Four patients with a mean age of 59 years (range 34 -
81 yrs) had laparoscopic reversal of their colostomies. There
were 2 males and 2 females with mean ages of 60 and 58 yrs,
respectively. The mean operative time was 178 minutes (range
148 - 220 min). No cases were converted to an open procedure.
All patients were started on a diet on post-operative day
1. The average length of stay (LOS) was 3 days (range 2 - 4
days). There were no morbidities or mortalities in this group.
This group was compared to a cohort of patients who underwent
open reversals of Hartmann’s procedures. There were 10
patients in this group with a mean age of 59 years (range 19 -
85 yrs). There were 4 males and 6 females with mean ages of
63 and 53 yrs, respectively. The mean operative time was 204
minutes (range 81 - 299 min). The average LOS was 6.4 days
(range 4 - 11 days).
Conclusion: Laparoscopic-assisted reversal of Hartmann’s procedure
using three 5 mm trocars can be done with minimal
morbidity and mortality. In addition, this can be done with
operative times that are comparable to the open approach
with much lower lengths of stay and faster recovery.
P114–Colorectal/Intestinal Surgery
PROSPECTIVE EVALUATION OF LAPAROSCOPIC SURGERY
FOR RECTAL CARCINOMA, Yukihito Kokuba MD, Takeo Sato
MD,Heita Ozawa MD,Takatosi Nakamura MD,Atushi Ihara
MD,Yosimasa Otani MD,Masahiko Watanabe MD, Kitasato
Univ Hospital
PURPOSE: This study was designed to examine the short-term
results of laparoscopy in the treatment of curable cases of rectosigmoidal
and rectal carcinoma. METHODS: A prospective
154 http://www.sages.org/
registry of 78 patients who underwent curative laparoscopic
resection for rectosigmoidal and rectal carcinoma between
July 1998 and June 2004 was reviewed. In 1998, we expanded
the application of laparoscopy to include T2 cancers located
anywhere in the rectum. Mesorectal transection was performed
at least 5 cm below the tumor for rectosigmoidal and
upper rectal lesions, and total mesorectal excision was performed
for lower tumors. Primary anastomosis by a doublestapling
technique or per anum handsewn coloanal anastomosis
was performed. Patient demographics and outcomes were
recorded prospectively. RESULTS: The median follow-up time
was 22 months. The median number of postoperative days on
which oral intake was resumed was 3, and the median length
of hospitalstay was 12 days. A total of 10 postoperative complications
occurred in 8 patients (11.1 percent) and included
anastomotic leakage in 4 (5.5 percent) and bowel obstruction
in 2 (2.7 percent). Reoperation was required in 4 patients. One
patient developed a recurrence of the cancer in the pelvic cavity.
CONCLUSION: The results of this study demonstrate the
feasibility and safety of laparoscopic surgery for selected
patients with rectal carcinoma. The morbidity and mortality
rates and oncologic outcome appear to be comparable to
those of conventional surgery.
P115–Colorectal/Intestinal Surgery
LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER -THE
SHORT- AND LONG-TERM OUTCOMES-, Juri Kondo MD,
Hideo Yamada MD, Toho University Sakura Hospital
We started laparoscopic colorectal surgery 10 years ago. We
reviewed our short- and long-term outcomes retrospectively.
PATIENTS : The indication were defined as the range from M
to SE. Between June 1994 and August 2004, 363 patients with
colorectal cancer underwent laparoscopic surgery with the
retroperitoneal approach method. The patient?fs average age
was 65.6 (range: 18-96). RESULTS: Ten cases (2.8%) were converted
to laparotomy, and nine of them were in the first 100
cases (9.0%). Two cases with ureter trauma were experienced
before the introduction of the retroperitoneal approach
method. After the first 100 cases, one case(0.4%) was converted
to laparotomy due to damage to the internal iliac vein during
the obturator lymph node dissection. With regard to postoperative
complications, there were 21 cases with ileus (5.8%).
Two of them were treated surgically and the other 19 cases
improved conservatively. Suture failure was experienced in 7
cases (1.9%) . The 5 year survival rate was 93.4%. There were
no port site implantaion.
This report presents a laparoscopic colectomy with the
retroperitoneal approach method that we have developed and
established as an approach to blood vessels for the treatment
of colon cancer. The short- and long-term outcomes of the
laparoscopic surgery we have perfomed were excellent.
P116–Colorectal/Intestinal Surgery
RECTOURETHRAL FISTULAS: A DIFFICULT PROBLEM EVEN
FROM A MINIMALLY INVASIVE PROCEDURE, Alex Jenny Ky
MD, Randolph Steinhagen MD,Donald Summers MD, Mount
Sinai School of Medicine
Purpose:Rectourethral fistula (RUF) is a relatively uncommon
condition, which can occur as the result of several etiologies.
The most common cause is iatrogenic injury related to the
management of prostatic disease. Repair of these fistulas can
be difficult and frustrating. We report our experience utilizing
gracilis muscle interposition for repair.
Method:Between 2001 and 2003 we treated four patients with
RUF following laparoscopic prostatectomy. The mean age of
the patients was 59. None of the 4 had received external beam
radiation prior to prostatectomy. One had evidence of residual
or recurrent cancer at the time of repair. The average interval
between prostatectomy and repair was four months. All
repairs were done via a perineal approach and utilized the
technique of gracilis muscle interposition. All of the 4 patients
had a stoma constructed prior to, or at the time of the repair.
The surgical team included a plastic surgeon, a urologist, and
a colorectal surgeon.
Result:The four patients required a total of five gracilis muscle
interposition procedures to obtain successful healing of the fistula.
One patient required repeat operation for re-fistulization.