2005 SAGES Abstracts

POSTER ABSTRACTS
tomies during this time period. The following table summarizes
the incidence of intra-abdominal abscess formation
based on surgical technique.
Conclusion: The two common methods of laparoscopic appendectomy
evaluated in this study are associated with similar
rates of post-operative intra-abdominal abscess formation. Use
of endoscopic loop ligation may be associated with an
increased rate of abscess formation in cases of gangrenous
appendicitis, though further confirmation based on
histopathology is required.
P139–Colorectal/Intestinal Surgery
CLINICAL AND EXPERIMENTAL STUDY ON ENDOSCOPIC
HEMOSTASIS BY LOCAL INJECTION OF FIBRIN GLUE-
HISTOPATHOLOGICAL OBSERVATION OF ITS HEMOSTATIC
AND WOUND HEALING EFFECTS, Hiroyasu Suga MD, Takao
Nakagawa MD,Yukihiro Soga MD,Haruki Takahashi
MD,Yoshizumi Deguchi MD,Takahiro Terada MD,Masatake
Ishikawa* MD,Tadashi Suzuki* MD,Yoshiaki Imamura**
MD,Masaru Fukuda** MD, Department of Emergency
Medicine, Tokyo Women’s Medical University Daini
Hospital.*Department of Emergency Medicine,Tokyo Women’s
Medical University.**Department of Surgical Pathology,
University Hospital, Faculty of Medicine, University of Fukui
[Introduction] Since October 2000, a fibrin glue has been used
for endoscopic hemostasis on 37 cases of hemorrhagic ulcer,
polypectomy, and control of hemorrhage in the EMR, and
found to be effective. In addition, the histological effect of a
local injection of fibrin glue was observed in rats. It was found
that, compared with a local injection of ethanol, a fibrin injection
results in less tissue trauma; and when compared to HSE,
its hemostatic effect was more reliable and longer lasting. In
the current study, dogs were used to evaluate the tissue regenerating
effect of a local injection of fibrin glue. The results are
introduced below.
[Methods] Under Nembutal anesthesia, mongrels were subjected
to a laparotomy and a hemorrhagic ulcer was mechanically
created in the pyloric vestibule.After prepared ulcers, the
lesion was treated with a local injection of fibrin glue (FG),
ethanol (ET), hypertonic saline-epinephrine (HSE), or physiologic
saline (sham). Then the wound was closed. The animals
were fed liquid feed on day 1 after surgery, then placed on a
normal diet and received postoperative care. On the 5th day
following surgery, the animals were subjected to a second
laparotomy and gastrectomy on the pyloric side (where the
ulcer had been created) to compare and evaluate the hemostatic
effects of the 4 agents.
[Results] The development of the regenerative epithelium was
most satisfactory in the FG group. The local injection did not
cause tissue damage but hemorrhage into the mucous membrane
and submucosal area was noted in the sham group. In
the former group, some tissue damage was recognized but fibrin
remained in the submucosal region until the 5th day, indicating
that the procedure had a sustained hemostatic effect.
The development of a regenerative epithelium was recognized
in the ET group. Although there was no hemorrhage, infiltration
by inflammatory cells was accentuated in this group. The
tissue damage was slight in the HSE group, but the development
of a regenerative epithelium was poor.
[Conclusion] Because fibrin persisted for a long period in the
area where it was injected, it was believed that a local injection
of fibrin glue has a sustained hemostatic effect. Compared
with the hemostatic agents that have been in use (such as
ethanol and HSE), the development of a regenerative epithelium
was good. Fibrin glue appears to be promising as a hemostatic
agent, as well as an agent to promote wound-healing.
P140–Colorectal/Intestinal Surgery
EFFECTIVENESS OF ELECTROTHERMAL BIPOLAR VESSEL
SEALER IN LAPAROSCOPIC COLECTOMY, Moriatsu Takada
MD, Takao Ichihara MD,Yoshikazu Kuroda MD, Department of
Gastroenterological Surgery, Graduate School of Medical
Sciences, Kobe University
INTRODUCTION: Lymphadenectomy at the origin of the middle
colic artery is sometimes difficult in laparoscopic transverse
colectomy (LTC). Recently, an electrothermal bipolar vessel
sealer (EBVS) has been inovated. We have developed the
affordable extended lymphadenectomy in LTC using EBVS.
METHODS AND PROCEDURES: From August 2001 through
July 2004, thirty-five consecutive patients with transverse
colon cancer underwent laparoscopic colectomy using non-clip
technique in Kobe University Hospital. Median patient age was
69.4 years. After the isolation of transverse colon, all vessels
were isolated and divided using EBVS except the main artery.
The transverse colon is rotated by centering at the base of
meso-colon and the anal side of the colon is pulled up vertically.
The middle colic artery was divided at the root with the dissection
of lymph nodes around the base of meso-colon. The
origin of main artery was then divided using EBVS. All other
surgical procedures were performed after the manner of standard
laparoscopic colectomy.
RESULTS : All procedures were performed successfully without
any kind of troubles. The average blood loss was 86.2 ?}
22.6 mL. The average operation time was 186.4 ?} 26.2 min.
Successful lymphadenectomy of the lymph node along the origin
of middle colic artery have been performed. There was no
postoperative death.
CONCLUSION:The method using EBVS may contribute to the
easy and safe LTC by improving the limited view of laparoscope
and raise a possibility for the laparoscopic resection of
advanced colon cancer. We convince that this rotation technique
and use of EBVS contribute to the easier and safe LTC.
P141–Colorectal/Intestinal Surgery
SURGERY OF RECTAL CANCER : LAPAROSCOPY DECREASE
THE LONG TERM MORTALITY BY CANCER., ERIC VIBERT,
CHRISTINE DENET MD,THIERRY PERNICENI MD,HUGUES
LEVARD MD,CHRISTOPHE VINDEVOGEL MD,BRICE GAYET
MD, INSTITUT MUTUALISTE MONTSOURIS, PARIS
Introduction:Laparoscopy in cancer remains discussed. This
study compared the long-term results of the treatment of the
rectal cancer by coelioscopy (C) and laparotomy (L).
Methods: Monocentric retrospective study of 245 patients
operated curatively (C=124 group and L=121 group) between
1994 and 2004. Groups were comparable (p>0,05) for the sex,
the age, the ASA score, the preoperative radiotherapy, the T
stage, the N stage, The M stage, the localization supra or infra
peritoneal of tumour, the type of resection, the distal margin
and the post-operative chemotherapy. Even if the rate of morbidity
and the length of hospitalization was comparable
between the two groups, the rate of post-operative reintervention
was higher in coelioscopy (p=0,04). The follow-up of the
groups were different: C=46 months/L=59 month (p=0,002).
The conversion rate was 13,2%. The role of the laparoscopy
(analyzes in intent-to-treat) was evaluated by a univariate
analysis then multivariate of the long-term results.
Results: In univariate analysis, the laparoscopy increased specific
survival (SS) (mortality by cancer) but not influence global
survival (GS) and survival without recurrence (SWR). In multivariate
analysis, the laparoscopy increased specific survival
(RR=0,355(0,126-0,995),p=0,04) like T1-T2 stage
(RR=0,121(0,160-0,943), p=0,04) and contrary to the age
(RR=1,06(1,01-1,11), p=0,007). At 36 months, the SS was 95.8%
after laparoscopy (68 patients at risk on 124) versus 88% after
laparotomy (84 patients at risk on 121) (p=0,005). At 36 months
GS, 93%(C) versus 83%(L), and SWR, 82%(C) versus 72%(L)
were not statistically influenced by the laparoscopy.
Conclusions: This study suggests that the laparoscopic treatment
of rectal cancer decrease the long term mortality by cancer.
P142–Colorectal/Intestinal Surgery
LAPAROSCOPIC SURGERY FOR COLORECTAL CANCER: EXPE-
RIENCE IN 500 SUCCESSFUL CASES, HM WANG MD, JB
CHEN MD, Division of Colorectal Surgery, Department of
Surgery, Taichung Veterans General Hospital
http://www.sages.org/
SAGES 2005
161