Division of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106-5047, USA.
Am J Surg. 2012 Mar;203(3):353-5; discussion 355-6. doi: 10.1016/j.amjsurg.2011.09.017. Epub 2012 Jan 20.
Learning curves and efficiency concerns have slowed the integration of laparoscopy into colorectal practice. We evaluated our experience with laparoscopic colorectal (LC) surgery using enhanced recovery pathways (ERPs).
One thousand consecutive LC procedures performed by 2 surgeons over a 5-year period using previously published, standardized ERPs were assessed.
The mean age was 59, and the mean body mass index was 29.5. Procedures included segmental colectomy (54%), proctectomy (19%), total colectomy (11%), ostomy (5%), and other procedures (11%). Diagnoses included malignancy (41%), diverticulitis (16%), inflammatory bowel disease (13%), and other (30%). The mean operative time was 151 minutes, and the mean blood loss was 55 mL. Conversion to an open surgery occurred in 5.8%, whereas 2.3% were performed using a hand-assist procedure. The mean hospital stay was 4.1 days (median 3), with a 6% readmission rate. Complications (20%) included mortality (0.3%), wound infection (4%), and anastomotic leak (1.4%).
LC surgery with ERP offers excellent outcomes with efficient use of resources.
学习曲线和效率问题减缓了腹腔镜技术在结直肠外科中的应用。我们评估了使用强化康复方案（ERPs）进行腹腔镜结直肠（LC）手术的经验。
对 2 位外科医生在 5 年期间完成的 1000 例连续 LC 手术进行评估，这些手术采用了之前发表的标准化 ERP。
患者的平均年龄为 59 岁，平均体重指数为 29.5。手术包括节段性结肠切除术（54%）、直肠切除术（19%）、全结肠切除术（11%）、造口术（5%）和其他手术（11%）。诊断包括恶性肿瘤（41%）、憩室炎（16%）、炎症性肠病（13%）和其他（30%）。平均手术时间为 151 分钟，平均出血量为 55 毫升。转为开放手术的比例为 5.8%，而手助手术的比例为 2.3%。平均住院时间为 4.1 天（中位数为 3 天），再入院率为 6%。并发症（20%）包括死亡率（0.3%）、伤口感染（4%）和吻合口漏（1.4%）。
使用 ERP 的 LC 手术可带来出色的结果，并能有效利用资源。
