2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
P120–Colorectal/Intestinal Surgery
DYNAMIC GRACILOPLASTY VERSUS IMPLANT OF ARTIFICIAL
SPHINCTER FOR TOTAL ANORECTAL RECONSTRUCTION
AFTER LAPAROSCOPIC ABDOMINOPERINEAL EXCISION,
Marco Maria Lirici MD, Massimiliano Di Paola MD,Cecilia
Ponzano MD,Yoshinori Ishida MD,Cristiano Hüscher MD,
Department of Surgery. San Giovanni Hospital. Rome. Italy
Abdominoperineal resection (APR) is still the standard treatment
of cancers close to the dentate line. Unfortunately a permanent
iliac colostomy is a severe limitation of the quality of
life. Attempts to construct a continent perineal colostomy after
anorectal excision have been done over the past 15 years with
uncertain benefits. The early results of 2 procedures consisting
of a laparoscopic approach to APR or reversal of APR, fashioning
of a perineal colostomy with dynamic graciloplasty or
implant of an artificial sphincter are herein reported.
Methods: Overall 6 patients underwent laparoscopic APR or
laparoscopic APR reversal and construction of perineal
colostomy with dynamic graciloplasty (3 pts) or implant of an
artificial bowel sphincter (AMS), in the last 4 years. All patients
had a diverting loop ileostomy at the time of surgery. Data
concerning operative management, morbidity and mortality
and the function of total anorectal reconstruction at the time of
operation, at postoperative month 1 and after ileostomy closure
were collected and analysed (SF36 form) in a prospective
non randomised fashion.
Findings: No postoperative complications occurred in the
group of dynamic graciloplasty (DG), whilst 1 patient of the
artificial sphincter (AS) group died for myocardial infartion
after ulceration of the prosthesis through the transposed colon
wall. Postoperative stay of remaining patients ranged 9 to 27
days. After 3 months the ileostomy was closed in all patients
but 1 in the DG group who died one day before rehospitalisation
for ostomy closure because of accidental not
disease/operation related reason. Follow-up of patients of the
DG and AS group ranged 3 to 24 and 2 to 8 months respectively.
Patients in the DG group had no complication and satisfactory
continence was showed at follow-up whereas all
patients in the AS group had early or late local complication
with ulceration of the prosthesis through the wall and consequent
removal and fashionin of a permanent iliac colostomy.
Interpretation: There are no published data on laparoscopic
APR and APR reversal with total anorectal reconstruction with
either dynamic graciloplasty or implant of artificial sphincter.
Preliminary results showed that laparoscopic APR or APR
reversal with continent perineal colostomy and dynamic
graciloplasty is a possible option in selected patients whilst
the implant of an artificial sphincter should be considered as
an unsafe procedure in such patients.
P121–Colorectal/Intestinal Surgery
COMPARATIVE STUDY BETWEEN LAPAROSCOPIC AND OPEN
ELECTIVE SURGERY FOR DIVERTICULAR DISEASE., Francisco
López-Köstner MD, Gonzalo Soto D. MD,Angélica García-
Huidobro D. MD,Francisca León G. MD,Maria Francisca
Arancibia,George Pinedo M. MD,María Elena Molina P.
MD,Demian A. Fullerton MD,Alvaro Zuñiga D MD, Department
of Digestive Surgery. Hospital Clínico Pontificia Universidad
Católica de Chile. Santiago. Chile
INTRODUCTION. Laparotomy has been the classical access to
the abdomen in elective surgery for diverticular disease (DD).
During the last decade, laparoscopic surgery of the colon has
showed a progressive development with results comparable to
open surgery. The aim of this study is to compare early results
of patients who underwent elective surgery for DD.
METHODS AND PROCEDURES. In 1998, we started a prospective
protocol on laparoscopic colorectal surgery. At present
(July 2004), we have operated on 139 patients and the surgical
indication was recurrent diverticulits in 51 of them. This group
was compared to the laparotomy group in the same period of
time. We excluded emergency surgery, and patients with
colonic fistulas. Fifty nine patients were operated on via
laparotomy (OS), and 51 laparoscopically (LS). Both groups
were statistically comparable in gender, previous laparotomies,
type of surgery performed, length of surgical specimens
and degree of histopathologic inflammation. The LS
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group was nevertheless significantly younger than the OS
group (53 v/s 59 years; p< 0,05). The continuous variables
were analyzed with the Student?s t test, and the categorical
variables with the Chi-square test, considering statistically significant
a p value < 0.05.
RESULTS. The mean operative time was significantly longer in
LS group (219 min. v/s 166 min.; p