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Techniques in Coloproctology

Published in:

01-05-2015 | Original Article

Laparoscopic versus open fecal diversion: does laparoscopy offer better outcomes in short term?

Authors: E. Gorgun, F. C. Gezen, E. Aytac, L. Stocchi, M. M. Costedio, F. H. Remzi

Published in: Techniques in Coloproctology | Issue 5/2015

Abstract

Background

Laparoscopic fecal diversion is performed in patients with complicated colon and rectal diseases. We aim to compare operative and short-term outcomes between laparoscopic and open fecal diversion.

Methods

After obtaining institutional review board approval, patients undergoing laparoscopic or open fecal diversion between February 2010 and September 2012 were reviewed. A straight comparison of the open and laparoscopic groups was made initially; then, patients who underwent laparoscopic fecal diversion were case-matched with open counterparts based on stoma type and primary diagnosis.

Results

While body mass index (BMI) was higher in the laparoscopy group (p = 0.04), American Society of Anesthesiologists (ASA) score (p = 0.33) and gender (p = 0.74) were comparable between the study groups in the straight comparison. In the case-matched analysis, type of prior operations (p > 0.05), age (p = 0.79), gender (p > 0.99), BMI (p = 0.1), and ASA (p = 0.25) score were comparable between the groups. Open surgery was associated with increased estimated blood loss (p = 0.01), longer hospital stay (p = 0.0002), higher postoperative ileus (p = 0.03), and higher readmission rates (p = 0.002).

Conclusions

Considering the short-term benefits as regards postoperative recovery and morbidity, fecal diversions should be performed laparoscopically when feasible.

Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopyassisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed

Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328CrossRefPubMed

Marcello PW, Wong SK (1999) Measuring outcomes of laparoscopic colectomy: is there an advantage? Semin Colon Rectal Surg 10:110–119

Hollyoak MA, Lumley J, Stitz RW (1998) Laparoscopic stoma formation for fecal diversion. Br J Surg 85:226–228CrossRefPubMed

Decanini-Teran C, Belmonte-Montes C, Cabello-Pasini R (2000) Laparoscopically created stomas. Rev Gastroenterol Mex 65:163–165PubMed

Zaghiyan KN, Murrell Z, Fleshner PR (2011) Scarless single-incision laparoscopic loop ileostomy: a novel technique. Dis Colon Rectum 54:1542–1546CrossRefPubMed

Ludwig KA, Milsom JW, Garcia-Ruiz A, Fazio VW (1996) Laparoscopic techniques for fecal diversion. Dis Colon Rectum 39:285–288CrossRefPubMed

Oliveira L (2003) Laparoscopic stoma creation and closure. Semin Laparosc Surg 10:191–196PubMed

Aytac E, Stocchi L, Ozdemir Y, Kiran RP (2013) Factors affecting morbidity after conversion of laparoscopic colorectal resections. Br J Surg 100:1641–1648PubMed

10.

Kronberg U, Kiran RP, Soliman MS et al (2011) A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score. Ann Surg 253:78–81CrossRefPubMed

11.

Braga M, Vignali A, Gianotti L et al (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–767CrossRefPubMedCentralPubMed

12.

Aytac E, Turina M, Gorgun E, Stocchi L, Remzi FH, Costedio MM (2014) Single-port laparoscopic colorectal resections in obese patients are as safe and effective as conventional laparoscopy. Surg Endosc 28:2884–2889CrossRefPubMed

13.

Aytac E, Stocchi L, Williams R, Remzi FH, Costedio MM (2014) Single-port laparoscopic fecal diversion: more than cosmetic benefits? Surg Laparosc Endosc Percutan Tech 24:e133–e136CrossRefPubMed

14.

Aytac E, Stocchi L, De Long J et al (2014) Impact of previous midline laparotomy on the outcomes of laparoscopic intestinal resections: a case-matched study. Surg Endosc 29:537–542CrossRefPubMed

15.

Tekkis PP, Senagore AJ, Delaney CP, Fazio VW (2005) Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg 242:8391CrossRef

16.

Tekkis PP, Fazio VW, Lavery IC et al (2005) Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg 241:262–268CrossRefPubMedCentralPubMed

17.

Aytac E, Stocchi L, Remzi FH, Kiran RP (2012) Is laparoscopic surgery for recurrent Crohn’s disease beneficial in patients with previous primary resection through midline laparotomy? A case-matched study. Surg Endosc 26:3552–3556CrossRefPubMed

18.

Kiran RP, Delaney CP, Senagore AJ, Millward BL, Fazio VW (2004) Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Arch Surg 139:39–42CrossRefPubMed

19.

Chiappa A, Zbar AP, Bertani E, Biella F, Audisio RA, Staudacher C (2001) Surgical outcomes for colorectal cancer patients including the elderly. Hepatogastroenterology 48:440–444PubMed

20.

Morner ME, Gunnarsson U, Jestin P, Svanfeldt M (2012) The importance of blood loss during colon cancer surgery for long-term survival: an epidemiological study based on a population based register. Ann Surg 255:1126–1128CrossRefPubMed

21.

Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 25:CD005033

22.

Hull TL, Joyce MR, Geisler DP, Coffey JC (2012) Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 99:270–275CrossRefPubMed

23.

Hiranyakas A, Rather A, da Silva G, Weiss EG, Wexner SD (2013) Loop ileostomy closure after laparoscopic versus open surgery: is there a difference? Surg Endosc 27:90–94CrossRefPubMed

24.

Goh YC, Eu KW, Seow-Choen F (1997) Early postoperative results of a prospective series of laparoscopic vs. Open anterior resections for rectosigmoid cancers. Dis Colon Rectum 40:776–780CrossRefPubMed

25.

Yau SL, Fok BK, Cheung HY et al (2013) Laparoscopic reversal of Hartmann’s procedure: safety and feasibility. Gastroenterol Rep (Oxf) 1:149–152CrossRef

26.

Segreti EM, Levenback C, Morris M, Lucas KR, Gershenson DM, Burke TW (1996) A comparison of end and loop colostomy for fecal diversion in gynecologic patients with colonic fistulas. Gynecol Oncol 60:49–53CrossRefPubMed

27.

Winkler MJ, Volpe PA (1982) Loop transverse colostomy—The case against. Dis Colon Rectum 25:321–326CrossRefPubMed

Title: Laparoscopic versus open fecal diversion: does laparoscopy offer better outcomes in short term?
Authors: E. Gorgun
F. C. Gezen
E. Aytac
L. Stocchi
M. M. Costedio
F. H. Remzi
Publication date: 01-05-2015
Publisher: Springer Milan
Published in: Techniques in Coloproctology / Issue 5/2015
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-015-1295-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic versus open fecal diversion: does laparoscopy offer better outcomes in short term?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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