Laparoscopic colorectal surgery. Analysis of the first 237 cases.

This study was made to prospectively assess the results of our first 237 consecutive patients who underwent laparoscopic or laparoscopic-assisted colorectal procedures. Between May 1995 and July 1999, two hundred thirty seven laparoscopic (assisted) colorectal procedures were performed: 97 sigmoidectomies, 31 right hemicolectomies, 26 rectosigmoidectomies, 23 abdominoperineal rectum amputations and 60 other procedures. The following parameters were recorded and analysed: patients gender, age, diagnosis, procedure, conversion to open surgery, peroperative and postoperative complications, duration of procedure, mortality and length of hospitalization. There were 104 men (44%) and 133 women (56%) with a mean age of 62 years. Hundred and fifty-one operations were performed for benign indications (diverticular disease (51.6%), benign colonic polyps (17.5%) and others (30.9%)) and 86 for cancer (palliative and curative). The conversion rate was 4%. Postoperative complications occurred in 65 patients (27%). In 20% of these cases re-operation was necessary. The most common cause was bowel obstruction. Surgery lasted an average of 110 minutes. Mean overall hospital stay was 11 days. Sixty per cent left the hospital within eight days after operation. The 60-day mortality rate was 2.9%. The feasibility and safety of laparoscopic colorectal surgery has been established in a variety of procedures for different indications. Care must be taken in the case of acute diverticulitis which in our series is associated with higher minor and major complication rate and conversion rate. Although our results for malign cases are good, the definitive incidence of neither port-site metastasis nor local recurrence is known and no long-term results after laparoscopic surgery for carcinoma are available, we believe that curative procedures for cancer should continue to be carried out only within the framework of prospective studies unless the patient is more than 75-year old, is in bad general condition or when a palliative procedure has to be performed.