2005 SAGES Abstracts

POSTER ABSTRACTS
operative time, narcotic requirement, time to oral intake,
length of hospital stay, and outcome. Comparison between
groups (open vs.laparoscopic) was analyzed using two-sample
t-tests and Wilcoxon rank sum tests.
Results
The two groups were similar in terms of age, clinical presentation
and diagnostic tests performed. The most common presenting
symptoms were chronic abdominal pain, nausea and
repeated vomiting. Symptoms such as chronic diarrhea, constipation,
weight loss and gastroesophageal reflux disease
(GERD) were also present but uncommon. Upper gastrointestinal
barium studies (UGI/SBFT) were diagnostic in all patients
with malrotation as compared to computed tomography (CT)
scanning which were falsely negative in 25%. Twenty-one
patients underwent the Ladd procedure, either open (n = 10) or
laparoscopic (n = 11). Three laparoscopic procedures were
converted to open but were analyzed in the laparoscopic
group in an intent-to-treat fashion. Overall, the laparoscopic
group resumed oral intake earlier than the open group (1.8 vs
2.7 days; p = 0.092), had a shorter hospital stay (4.0 vs. 6.1
days; p = 0.050) and required less narcotics on the first postoperative
day (4.9 vs 48.5 mg; p = 0.002). The laparoscopic group
underwent a longer operation (194 vs. 143 minutes; p = 0.053).
Follow-up ranged from 2 weeks to 97 months (mean, 42
months) and was complete in 18 of 21 (86%) patients. Sixteen
patients reported complete resolution of symptoms, while 2
felt greatly improved. No patient required a second operation
related to volvulus or recurrent symptoms.
Conclusions
The laparoscopic Ladd procedure is feasible, safe, and as
effective as the standard open Ladd procedure to treat adults
with intestinal malrotation without midgut volvulus. Patients
also benefit from this minimally invasive approach as manifested
by earlier oral intake, a decreased need for intravenous
narcotics and an earlier dismissal from the hospital.
P124–Colorectal/Intestinal Surgery
ABNORMAL LIPID PROFILE-RISK FACTOR FOR THE FORMA-
TION OF COLONIC DIVERTICULOSIS AMONG YOUNG
PATIENTS?, Leonidas S Miranda MD, Kenneth Lee MD,
Fairview Hospital, Cleveland Clinic Health System, Department
of Surgery
Purpose: Colonic diverticulosis among young patients may
have different risk factors when compared to the known factors
for the disease affecting the elderly. Because obesity has
been reported as comorbidity, we hypothesized that abnormal
lipid profile (also related to obesity) is a risk factor for the disease
among young patients.
Methods: Following IRB approval, patients aged 45 years and
younger (107) admitted at a teaching hospital with diverticulitis
between January 1997 and December 2001 as well as
healthy adults (controls) were invited for a fasting lipid profile
test (results analyzed using an unpaired t-test).
Results: The mean age of the study group was 38.5 years (22-
45) at the time of initial admission to the hospital, 64% males
and 36% females. Values for 9 patients were available from the
hospital records and 24 responded to the invitation (N = 33).
Of these patients, 20 (60.6%) showed dyslipidemia. The mean
age of the control group (N=27) was 32.5 years (19-45); 5
(18.5%) of them had dyslipidemia.
Conclusions: Abnormal lipid profile may represent a risk factor
for colonic diverticulosis among young patients. Obesity is a
common comorbidity, but our data suggest no significant difference
between the study and control groups. Dyslipidemias
may serve as a marker of the primary effects of increased
dietary fats on the colonic mucosa.
P125–Colorectal/Intestinal Surgery
LAPAROSCOPIC COLECTOMY FOR ATTENUATED FAMILIAL
ADENOMATOUS POLYPOSIS (AFAP), E Monteferrante MD, N
Pitrelli MD,E Liberatore MD,G Palka* MD,G Colecchia MD,
Department of Surgery “Santo Spirito” Hospital Pescara ,
*Department of Medical and Molecular Genetics Chieti
University Italy
Introduction
Over the last decades has been described a variant of familial
adenomatous polyposis (FAP) called attenuated FAP (AFAP).
AFAP is not well-defined as a disease entity and the diagnostic
criteria and methods of investigation differ markedly. The incidence
and frequency of AFAP is unknown. The mutations in
APC gene, associated with AFAP, have mainly been detected in
three parts of the gene: in the 5’ end (the first five exons), in
exon 9 and in the distal 3’ end. The main features of AFAP are
100 or less colorectal adenomas with a tendency to rectal sparing,
a delay in onset of adenomatosis and bowel symptoms of
20-25 years, a delay in onset of colorectal cancer (CRC) of 10-
20 years and death from CRC of 15-20 years, and although the
lifetime penetrance of CRC appears to be high, CRC doesn?t
seem to develop in nearly all affected patients. A more limited
expression of the extracolonic features is seen, but gastric and
duodenal adenomas are frequently encountered.
Case Report:
The patient is a female, aged 41 years, with a diagnosis of
AFAP characterized by a mutation in the distal 3? end of APC
gene, undergoing annualy colonoscopy with polipectomy from
about ten years. The biopsy (histologic test) of a polyp in the
distal trasverse, ablated not with endoscopy, evidentiated
areas of severe dysplasia . The patient underwent total colectomy
with ileorectal anastomosis (IRA) with laparoscopic surgery
. Five trocards has been used and an incision according
to Pfannenstiel. Duration of surgery has been 350 minutes and
no complications have been recorded during and after surgery.
In ninth day the patient has been discharged with 3-4 daily
evacuations. Besides the presence of multiple adenomatous
polyps ( < 20 ) the definitive histologic exam has also evidentiated
, in the previous polyp, areas of adenocarcinomatosis,
which infiltrated the muscolaris mucosae. The examinated 36
lymphnodes have not been infiltrated. The rettoscopy performed
after 6-12 months has resulted negative
Conclusion
Prophylactic colectomy with IRA is recommended in most
patients with AFAP . Laparoscopic surgery is possible, safe
and efficacy.
P126–Colorectal/Intestinal Surgery
LAPAROSCOPIC LOW ANTERIOR RESECTION FOR ADVANCED
RECTAL CANCER, YASUHIRO MUNAKATA MD, HITOSHI SEKI
MD,YUSUKE MIYAGAWA MD,HIROSI SAKAI,KEN HAYASHI,
NAGANO MUNICIPAL HOSPITAL
[purpose]
The Japanese RCT of laparoscopic and open surgical therapy
for the advanced colon cancer is going to begin by main institutions
of the whole country since autumn, 2004. In most of
the past RCT for colon cancer , treatment outcome was similar
between laparoscopic and open surgery.
If operative procedure is good, the superiority of laparoscopic
surgery for advanced rectal cancer will be similar with colon
cancer, although the operation procedure for rectal cancer is
more complicated than colon cancer. Therefore, we reviewed
low anterior resection for the advanced rectal cancer treated
under laparoscopic and open procedure.
[subjects and methods] We performed laparoscopic low anterior
resection in 34 cases of curative advanced rectal cancer
(LLAR), and open low anterior resection in 20 cases (OLAR).
We reviewed about operation results, complications and long
term prognosis.
[results ] There were 34 cases of curative laparoscopic low
anterior resection among 85 cases of rectal cancer treated by
endoscopic surgery . We compared LLAR with OLAR. We performed
lymph node dissection of D2 or D3 under pneumoperitoneum
in LLAR. We experienced 3 examples of transient urination
disorder, 2 examples of wound infection and a bowel
obstruction for a complication of LLAR. A complication of
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