Rosin Danny, Zmora Oded, Hoffman Aviad, Khaikin Marat, Bar Zakai Barak, Munz Yaron, Shabtai Moshe, Ayalon Amram
Department of General Surgery and Transplantation, Sheba Medical Center, Tel Hashomer, Israel.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):604-7. doi: 10.1089/lap.2006.0002.
Postoperative adhesions are a major cause of morbidity, accounting for approximately 5% of the readmissions of surgical patients. Bowel obstruction is attributed to adhesions in more than half of the cases, many of which are following colon and rectal surgery. Laparoscopic surgery has the potential advantage of reduced adhesion formation owing to attenuated surgical trauma, less tissue handling, and smaller scars. However, the translation of these advantages to a reduced rate of bowel obstruction has not been sufficiently demonstrated. The aim of this study was to assess the rate of adhesion-related bowel obstruction after laparoscopic colon and rectal surgery.
Data regarding all cases of laparoscopic colon and rectal surgery were prospectively collected. Information relative to demographics, surgical procedures, and follow-up was analyzed, and patients who were readmitted for bowel obstruction were identified.
Over a period of 8 years, 306 patients, at a mean age of 63 years, had a laparoscopic colon and rectal operation in our department-122 for benign conditions and 184 for malignant disease. The mean length of follow-up was 38 months. Six cases (2%) of bowel obstruction, which were unrelated to hernia or advanced cancer, were identified. Two patients had a history of open surgery, in addition to the laparoscopic procedure, so adhesions could be attributed solely to the laparoscopic procedure in 4 patients, which consisted of 1.3% of the total study group. Obstruction occurred within 2 weeks of surgery in 2 patients, and one early reoperation was required.
The incidence of adhesion ileus after laparoscopic colon and rectal surgery appears to be very low. This long-term benefit of laparoscopic surgery should be considered when comparing this technique to its open counterpart.
术后粘连是发病的主要原因，约占手术患者再次入院人数的5%。超过半数的肠梗阻病例归因于粘连，其中许多发生在结肠和直肠手术后。由于手术创伤减轻、组织处理较少和疤痕较小，腹腔镜手术具有减少粘连形成的潜在优势。然而，这些优势转化为降低肠梗阻发生率的情况尚未得到充分证实。本研究的目的是评估腹腔镜结肠和直肠手术后粘连相关肠梗阻的发生率。
前瞻性收集所有腹腔镜结肠和直肠手术病例的数据。分析与人口统计学、手术程序和随访相关的信息，并确定因肠梗阻再次入院的患者。
在8年的时间里，我们科室有306例患者接受了腹腔镜结肠和直肠手术，平均年龄63岁，其中122例为良性疾病，184例为恶性疾病。平均随访时间为38个月。确定了6例（2%）与疝气或晚期癌症无关的肠梗阻病例。2例患者除了接受腹腔镜手术外，还有开放手术史，因此粘连可能仅归因于腹腔镜手术的有4例患者，占总研究组的1.3%。2例患者在手术后2周内发生梗阻，需要进行1次早期再次手术。
腹腔镜结肠和直肠手术后粘连性肠梗阻的发生率似乎非常低。在将这种技术与其开放手术对应技术进行比较时，应考虑腹腔镜手术的这种长期益处。
