Leverkusen General Hospital, Department of General Surgery, Leverkusen, Germany.
Dis Colon Rectum. 2009 Oct;52(10):1738-45. doi: 10.1007/DCR.0b013e3181b552cf.
Laparoscopic-assisted sigmoidectomy is an attractive but sometimes challenging operative technique for the treatment of diverticulitis of the sigmoid colon. The aim of this study was to compare, with respect to early postoperative analgesic demand and postoperative pain, laparoscopic-assisted sigmoidectomy with a laparoscopic-facilitated technique. In the laparascopic-facilitated technique, the sigmoid colon is removed conventionally via a cosmetically inconspicuous incision after prior laparoscopic mobilization.
Patients subjected to elective sigmoidectomy for diverticulitis were randomized to either laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy. All patients had piritramide-based, patient-controlled analgesia. The cumulative postoperative consumption over 96 hours was defined as the primary end point. Postoperative pain, fatigue, pulmonary function, and resumption of bowel function were secondary endpoints.
: Forty-five patients were randomized according to the protocol to laparoscopic-assisted sigmoidectomy (n = 22) or laparoscopic-facilitated sigmoidectomy (n = 23). The analgesic consumption between the two groups was equivalent (61.3 (9-171) mg piritramide/96 hours vs. 64.3 (18-150) mg piritramide/96 hours; P = 0.827). Patients with laparoscopic-assisted sigmoidectomy had lower pain levels on Day one and Day two. Cumulative pain levels over 96 hours and over the whole 7-day observation period, however, were not significantly different, although postoperative fatigue and pulmonary function were significantly different. Duration of surgery was slightly shorter for laparoscopic-assisted sigmoidectomy (127 (47-200) vs. 135 (60-239) minutes; P = 0.28), but recovery of bowel activity was faster after laparoscopic-facilitated surgery. There was no significant difference in morbidity.
Overall, the postoperative outcome was roughly equivalent after both techniques of laparoscopic sigmoidectomy. Therefore, laparoscopic-facilitated sigmoidectomy could be considered as an alternative to laparoscopic-assisted sigmoidectomy in technically difficult cases of diverticulitis subjected to laparoscopic surgery.
腹腔镜辅助乙状结肠切除术是治疗乙状结肠憩室炎的一种有吸引力但有时具有挑战性的手术技术。本研究旨在比较腹腔镜辅助乙状结肠切除术和腹腔镜辅助技术在术后早期镇痛需求和术后疼痛方面的差异。在腹腔镜辅助技术中，乙状结肠在腹腔镜游离后通过美容上不显眼的切口常规切除。
接受择期乙状结肠憩室炎切除术的患者被随机分为腹腔镜辅助组或腹腔镜辅助组。所有患者均采用哌替啶为基础的患者自控镇痛。96 小时内的累积术后消耗量定义为主要终点。术后疼痛、疲劳、肺功能和肠道功能恢复为次要终点。
根据方案，45 例患者被随机分为腹腔镜辅助乙状结肠切除术（n=22）或腹腔镜辅助乙状结肠切除术（n=23）。两组的镇痛消耗量相当（61.3（9-171）mg 哌替啶/96 小时 vs. 64.3（18-150）mg 哌替啶/96 小时；P=0.827）。腹腔镜辅助组患者在术后第 1 天和第 2 天的疼痛水平较低。然而，96 小时和整个 7 天观察期内的累积疼痛水平没有显著差异，尽管术后疲劳和肺功能有显著差异。腹腔镜辅助组的手术时间略短（127（47-200）vs. 135（60-239）分钟；P=0.28），但腹腔镜辅助组术后肠道活动恢复更快。发病率无显著差异。
总的来说，两种腹腔镜乙状结肠切除术的术后结果大致相当。因此，在技术上困难的腹腔镜手术治疗憩室炎病例中，腹腔镜辅助乙状结肠切除术可以考虑作为腹腔镜辅助乙状结肠切除术的替代方法。
