2005 SAGES Abstracts

POSTER ABSTRACTS
divided to two major categories, the Mega-colon involving
only the sigmoid colon (sigmoid colon volvulus) and the
extended Mega-colon involving all proximal colon. On the
patients with sigmoid colon volvulus(Type??), we have performed
sigmoidectomy through a 4 cm incision (with a laparoscope
as a bach-up ). On the patients with the extended Megacolon
involving all proximal colon (Type ? ), we have performed
subtotal colectomy using gasless HALS with our
unique lifting bar that consists of a bent, stainless steel rod
5mm in diameter. We have performed these methods on 11
patients consisting of 9 Type I patients and 2 Type? patients,
after enough bowel preparation.
RESULTS : There are neither major complications nor conversions
to conventional open surgery. All of the patients had
more than one bowel movement a day with a low dose of laxatives.
CONCLUSIONS : On the patients with Type??, the sigmoid
colon was not attached to retroperitoneal tissue, therefore the
elongationed sigmoid colon could be easily removed from the
abdominal cavity and operated on extracoroporeally. On the
patient with Type? , by performing the operation not only
under laparoscopy, but also via the small incision, the operation
time can be shortened and the operation procedure is
simplified. This combined technique is an advantage of gassless
surgery.
P131–Colorectal/Intestinal Surgery
A CASE OF PERITONEAL DISSEMINATION ACCOMPANIED BY
PORT SITE METASTASIS EIGHT MONTHS AFTER INITIAL
LAPAROSCOPIC RESECTION OF SIGMOID COLON CANCER.,
Mitsuyoshi Ota MD, Shigeki Yamaguchi MD,Hirofumi Morita
MD,Masayuki Ishii MD, Shizuoka Cancer Center
A sixty-one year old woman who developed sigmoid colon
cancer, underwent sigmoidectomy at our institution on
October second, 2003. Inraoperative peritoneal lavage cytology
was negative. We had difficulty with dissection of the firm
adhesion of the greater omentum in the lower peritoneal cavity.
After high ligation of IMA and mobilization, we made a
transverse incision in the lower abdominal region, 6cm in
diameter, attached a wound protecter, extracted the intestine,
cut the proximal and distal side of the intestine, and anastomosed
the intestine using functional end-to-end anastomosis.
During the course of this procedure, the mesocolon was widely
damaged. Pathological finding confirmed that the tumor
was resected curatively and the staging was pT4 N1 M0. Eight
months after the initial operation, multiple disseminated tumor
was detected in CT scan and Positron Emission Tomography,
accompanied by a port site recurrence which recognized at the
assistant?fs port site of right lower abdomen.
P132–Colorectal/Intestinal Surgery
LAPAROSCOPIC COLON RESECTION PERFORMED IN A COM-
MUNITY-BASED TEACHING HOSPITAL, D J Reichenbach MD,
A D Tackett MD,A Stiles BS,J Harris MD, New Hanover
Regional Medical Center
PURPOSE: The purpose of this study was to review the first 50
laparoscopic colon resections performed by two surgeons at a
community-based teaching hospital. METHODS: A retrospective
chart review was conducted of the first 50 patients undergoing
laparoscopic colon resection at New Hanover Regional
Medical Center from January 2002 to May 2003. Conversions
to open resections were included in the data collection and
analysis. RESULTS: The majority of the patients were
Caucasian and female (92% and 68% respectively). Sixty-two
percent had undergone previous abdominal surgery. The
mean age of patients undergoing resection was 64 ± 13.5
years, and the mean BMI was 28.6 ± 5.3 kg/m2. The most common
indications for surgery were diverticulitis (44%) and
polyps (32%). Twenty percent of resections were undertaken
with a pre-operative diagnosis of malignancy. The majority of
procedures performed were sigmoid colectomies (56%), followed
by right hemicolectomy (34%), and transverse colectomy
(10%). Sixty-four percent were totally laparoscopic procedures,
10% were lap-assisted, and 14% were hand-assisted.
The conversion to open rate was 12%. Mean operating time
was 161 ± 41 minutes. The overall complication rate was low,
with 5 (10%) wound infections, 1 (2%) wound dehiscence, 3
(6%) small bowel obstructions, and 2 (4%) instances of perioperative
bleeding requiring transfusion. The 30-day mortality
rate was zero. The mean length of stay for the entire study
group was 5.0 ± 4.1 days. CONCLUSIONS: Laparoscopic colon
resection offers several advantages to the traditional open
technique. Laparoscopic colon resection can be performed
safely in the community hospital setting provided that the surgeon
possesses advanced laparoscopic skills. A learning curve
exists, and the transition from open to laparoscopic resection
can be bridged by the use of hand-assist devices.
P133–Colorectal/Intestinal Surgery
LAPAROSCOPIC VERSUS OPEN COLOSTOMY REVERSAL: A
COMPARATIVE ANALYSIS, Michael J Rosen MD, William S
Cobb MD,Kent W Kercher MD,Andy G Harrell MD,Yuri W
Novitsky MD,Ron F Sing DO,B Todd Heniford MD, Carolinas
Medical Center
Purpose: Open colostomy reversal carries significant rates of
anastomotic leak, wound infection, and incisional hernia often
limiting its acceptance. We hypothesized that the laparoscopic
approach to the restoration of intestinal continuity may result
in lower perioperative morbidity and faster postoperative
recovery.
Methods: 22 cases of laparoscopic colostomy reversals performed
at a single institution were identified and compared to
22 randomly selected open colostomy closures performed during
the same time period. Patients were compared based on
demographics, previous indications for colostomy procedures,
and perioperative outcomes.
Results: A total of 150 patients underwent reversal of left sided
colostomies during the study period. The laparoscopic
approach was successful in 20 of 22 cases; there were 2 conversions
to open (10%) secondary to inability to localize the
rectal stump. The laparoscopic and open groups were comparable
based on mean age (54 years v 49 years; p=0.23), BMI
(26kg/m2 v 27kg/m2; p=0.66), Sex (9%males v 13%; p=0.23),
ASA (2.6 v 2.3; p=0.07), and history of previous intra-abdominal
sepsis (17 v 16 cases). Operative times were similar (158
min v 189 min; p=0.16), and EBL was significantly less in the
laparoscopic group (113cc v 270cc; p=0.01). No intraoperative
complications occurred in the laparoscopic group and two
enterotomies occurred in the open group. The laparoscopic
group had earlier passage of flatus (3.5d v 5.0d; p=0.001) and
shorter hospitalization (4.2d v 7.3d; p=0.001). Perioperative
complications occurred in 3 (14%) laparoscopic and 13 (59%)
open cases (p=0.01). There was no mortality in this series.
Conclusions: The laparoscopic approach can be safely
employed in the restoration of intestinal continuity. It results in
a decreased perioperative morbidity and faster recovery. It
offers distinct advantages over the open approach to colostomy
reversal.
P134–Colorectal/Intestinal Surgery
SHORT AND LONG TERM RESULTS IN 306 LAPAROSCOPIC
COLORECTAL PROCEDURES, Danny Rosin MD, Oded Amora
MD,Aviad Hoffman MD,Marat Khaikin MD,Barak Bar Zakai
MD,Yaron Munz MD,Moshe Shabtai MD,Amram Ayalon MD,
Sheba Medical Center, Tel Hashomer, Sackler Scool of
Medicine, Tel Aviv, Israel
Background : Laparoscopic surgery has recently gained wide
acceptance in the treatment of colorectal pathologies, including
cancer. Long term outcome however requires further
assessment. The aim of this study is to evaluate short and
long term outcomes after 8 years of performing laparoscopic
colon and rectal surgery.
Methods: Data relative to all patients who underwent laparoscopic
colon and rectal surgery in our department was
prospectively recorded. Demographics, operative procedure,
post operative course, oncologic treatment and follow-up data
were reviewed in this study. Survival was calculated for
patients with cancer who completed at least 3 years of followup.
Results: 306 procedures were performed over a period of 8
years, 184 (60%) for malignancy and 122 (40%) for benign conditions.
The number of procedures stabilized at around 50 per
year, and included right colectomy (81), sigmoidectomy (80),
Anterior resection (55) and left colectomy (34), and other pro-
http://www.sages.org/
SAGES 2005
159