Hand-assisted total colectomy: a safe alternative

• DOI: 10.1007/s10353-009-0464-y
• Publication Date: 2009-07-02T06:32:47Z
• Authors: M. D. Santos; D. Silva; C. Nogueira
• Keywords: 03 medical and health sciences; 0302 clinical medicine; 3. Good health

BACKGROUND: Our Department has been performing laparoscopic surgery for colorectal disease since 1998. More recently, we have introduced hand-assisted procedures in selected patients. The purpose of this study is to analyze our results with hand-assisted laparoscopic surgery in total colectomy. METHODS: A consecutive series of patients undergoing hand-assisted laparoscopic total colectomy were analyzed from prospectively collected data from October 2003 to October 2008. All the procedures were performed by a single surgeon. Twenty one patients underwent hand-assisted total colectomies: nine females and twelve females, with mean age of 43.6 years (range 17–72). Indications included: attenuated familial adenomatous polyposis (15), colon cancer in Lynch syndrome (5) and colonic inertia (1). Six patients had prior abdominal surgery. Results regarding time of operation and post-operative hospital stay were then compared against data from open and regular laparoscopic surgery occurred at same period. The Kruskal–Wallis test with a significance level of 0.05 was adopted. RESULTS: HALS median surgery time was decreased by 110 min (range 210–320; p<0.001) when compared to laparoscopic surgery times. No statistical significant changes were found between HALS and open surgery. Regarding post-operative hospital stay, when comparing HALS with open surgery, median length shortens by 4 days (p<0.001). No significant differences were found when comparing HALS with laparoscopic total colectomy. CONCLUSIONS: Hand-assisted laparoscopic total colectomy combines the advantages of laparoscopic-assisted surgery regarding post-operative stay, when compared to open surgery, with reduction of the operative time to that of open surgery.