here - Malaysian Society of Colorectal Surgeons

P O S T E R 1 5HAND-ASSISTED LAPAROSCOPIC ABDOMINO-PERINEAL RESECTIONUTILISING PLANNED END COLOSTOMY SITED C Koh, C W Law, W K Cheong, C B TsangDivision of Colorectal Surgery, Department of Surgery, National University Hospital, SingaporeO B J E C T I V ETo evaluate the technique of hand-assisted laparoscopic (HAL) abdomino-perineal resection (APR)utilizing the planned end colostomy site in patients with low rectal cancer.PAT I E N T S A N D M E T H O D S6 patients with low rectal cancer who were unsuitable for a sphincter salvage procedure were recruited.The stoma site was marked prior to the operation. A transverse incision was made over the markedcolostomy site for hand device placement. Surgery was performed in the usual manner as in HAL surgery.After the specimen was delivered, polydioxanone sutures were used to appose the rectus fascia in aninterrupted fashion, leaving an approximate gap in the central part of the incision for the colostomy.The skin edges were then apposed using an absorbable suture, and the end colostomy created in thestandard fashion.R E S U LT S4 males and 2 females with a mean age of 61 (38 – 76) years were recruited. All the procedures werecompleted without any intra-operative complication or conversion. Length of incision for hand deviceplacement was 6.13 (6 – 6.5) cm in average. The mean operative time was 212 (150 – 295) minutes.During the post-operative recovery period, normal diet was tolerated after a mean of 4.33 (4 – 6) days.1 patient developed post-operative ileus but this resolved spontaneously. No wound infection was noted.The maximal pain score on the first, second and third post-operative days were 5, 3 and 2 respectively.The average length of hospital stay was 5.6 (4 – 9) days. After a mean follow-up of 13.3 months, onepatient developed a parastomal hernia. None of the patient had any evidence of local tumour recurrence.C O N C L U S I O N SHAL APR with the hand device placed at the planned stoma site is technically feasible. Without creatingan additional incision, the operation is oncologically comparable, with a shorter operative timecompared to straight laparoscopic methods, whilst maintaining the benefits of a minimally invasiveapproach.45