Introduction. Laparoscopic colorectal surgery is an advanced laparoscopic procedure but is fully accepted in both benign and malignant colorectal diseases. In malignant diseases with adherence to oncological criteria while maintaining the benefits of miniinvasive operations. Some authors consider laparoscopy in colorectal surgery as the gold standard.
Materials and methods. Authors analyze a group of patients operated for colorectal diseases at the Department of Miniinvasive Surgery in the FNsP FDR BB from 1 January 2007 to 31 December 2019. During this period we performed 736 primary laparoscopic colorectal operations. All operations were performed in one department miniinvasively – laparoscopically. There were three colorectal surgeons. We analyzed the data comprehensively retropectively from tables kept in the perioperative period and in the follow-up.
Results. A total of 222 low anterior rectal resections were performed for the malignant or benign lesion located in the rectum. Of the 222 patients undergoing rectal resection, 203 (91.44 %) underwent LAR for malignant diagnosis (including Carcinoma in situ) and 19 patients (8.56 %) for benign rectal lesion. The average operating time was 145 minutes. In 2007, when laparoscopic low anterior rectal resections were in our department at the beginning, the average operating time was 202 minutes, while in 2019 it dropped to 142 minutes under the learning curve.
In the group of patients, complications requiring surgical review occured in 11.7 % of cases (26 patients). We re-operated 18 patients (8.1 % for anastomosis type C dehiscence according to the ISGRC (International Study Group of Rectal Cancer) when derivative stoma (transversostomy – almost always or ileostomy) and small pelvis drainage with antibiotic treatment were created. In three patients (1.35 %) we performed reoperation for an ileal condition, two patients (1.35 %) underwent fascia resection for its dehiscence, and urgently were reoperated 3 patients for bleeding into the abdominal cavity.
Conclusion. According to retrospective analysis our results are fully comparable with the world literature and the method is considered safe, oncologically precise, while postoperative course is more favorable in patients after laparoscopic resections, with faster onset of peristaltis, with lower inflammatory response of the organism. After the introduction of the ERAS protocol and the use of preoperative and postoperative nutritional support, we reduced the average postoperative hospitalization period to 4 days. Authors discuss the possibility of laparoscopic rectal surgery performing without protective ileostomy, without any increased risk of anastomotic leaks number or mortality.
Key words: laparoscopic colorectal surgery, laparoscopic rectal resection, retrospectiv analysis rectal resections in period 2007 – 2017, analysis of complications, protective ileostomy.
Lek Obz, 2020, 69 (9): 278-284
Ľubomír MARKO, Michal GURIN, Nina LAJMONOVÁ, Barbara MRÁZOVÁ, Peter VLADOVIČ
1II. chirurgická klinika SZU, Oddelenie miniinvazívnej chirurgie, FNsP FD Roosevelta, Banská Bystrica, prednosta
doc. MUDr. Ľ. Marko, PhD.
2FZ SZU, Banská Bystrica, dekanka doc. PhDr. Bc. B. Frčová, PhD., MPH, mim. prof.
Ľubomír MARKO, Michal GURIN, Nina LAJMONOVÁ, Barbara MRÁZOVÁ, Peter VLADOVIČ: Complications after laparoscopic rectum surgery – retrospective analysis – 2007 – 2019. Lek Obz, 2020, 69 (9): 278-284