In the time between June 2003 and July 2007. A total of 170 laparoscopic surgeries performs, the average age of the population is 54 years (18-89 years). Of this total only a total of 163 procedures, with a conversion rate of 8.8% (15 patients). Laparoscopic Trainer Box.
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Six conversions were in cancer patients and nine in patients with Hinchey III complicated diverticulitis. Also 66% (112) of the cases performs in male patients and the rest (58 patients) in the female sex. Laparoscopic Trainer Box.
Main Indication Disease
The main indication was diverticular disease 67, followed by colorectal cancer (52 cases). The most frequently performed surgical procedure was sigmoidoscopy 73, followed by right hemicolectomy 31.
Surgical time in cases of benign disease was 125 minutes (range 50-360), intraoperative bleeding 110 mL (range 50-700). The mean diet tolerance time 3.1 days (range 1-18) with a mean hospital stay 4.1 days (range 2-25). Laparoscopic Trainer Box.
Analysis Of Results of Malignant Disease
When we analyze the results in malignant diseases. The surgical time was 120 minutes (range 50-216). Bleeding 116 mL on average (range 40-650), diet tolerance time 4.1 days (range 2-18) and a hospital stay of 5.1 days (range 3-14).
When we analyzed the cases of malignant disease. With the most frequent histological lineage moderately differentiates (n = 39), followed by well (n = 10) and poorly differentiated (n = 3).
Lymph Nodes Resection
The mean number of lymph nodes resected in the surgical piece for procedures for malignant disease was 15.69 (± 3.53). With a recurrence of 6% (n = 3) during the follow-up period with a median of 24 months. The distribution by stage according to the procedures. Laparoscopic Trainer Box.
Minor And Major Morbidity
Morbidity divides into minor and major. The least, 4.8% (7), including surgical wound infection 4, serous 2, and post-incisional hernia. The highest was 7.5% (11), including dehiscence with local abscess 4, ureteral injury 2. Surgical wound infection plus dehiscence and generalized abdominal sepsis 2, sterile collection and sub occlusion 1.
A total of 8 patients (5.3%) underwent reoperation, six of them due to abdominal sepsis (75%). Secondary to anastomosis dehiscence (3), and in 5 of them due to abdominal collections, and in 2 of them due to small bowel obstruction (25%). Mortality occurred in a case secondary to abdominal sepsis and corresponds to 0.6%. Laparoscopic Trainer Box.
Conversion To the Open Approach
About the patients who required conversion to the open approach. Of 6 of them due to complicated diverticular disease was due to difficulty in evaluating structures (ureters). As well as their integrity (bladder) safely. In the cases of malignant disease, it was when adhesion to other involved structures (T4) finds, diagnosed in the preoperative period.
So, when it converted, the morbidity of the procedures not modifies. And in this way, it manages with the appropriate surgical principles both for benign and malignant disease. Laparoscopic Trainer Box.
In the field of minimally invasive surgery, it currently accepts that it is the approach of choice for performing cholecystectomy and anti-reflux surgery. However, in colorectal surgery, more than a decade after the first laparoscopic colectomy. The real role still evaluates, especially when we talk about surgery for rectal cancer.
The classic advantages attributed to this type of approach are as follows:
- Shorter hospital stays,
- Better cosmesis,
- Earlier recovery,
- Lower rate of complications related to the surgical wound, and
- Less bleeding,
On the other hand.
Some related disadvantages are known to the procedure:
- Such as a lengthier surgical time and
- A higher cost of the procedure.
Treatment For Gentle Pathologies
This series with 170 cases is small when compared to those in the literature, the mean age of 54 years, a relatively young sample explains by the number of patients treated for benign pathologies such as diverticular disease and inflammatory bowel disease, among other. Laparoscopic Trainer Box.
Most Frequent Treatment
As previously mentioned, the most frequently treated type of pathology is diverticular disease in its entire spectrum, followed by colorectal cancer. The most frequently performed procedure is sigmoidoscopy, followed by right hemicolectomy, lower anterior resections, and proctocolectomies.
Our conversion rate is less than 10% (15 patients), which is within the ranges shown in the literature. It is worth mentioning that most of these conversions were due to Hinchey III diverticular disease. This is due to the technical difficulty in performing minimally invasive surgery in the context of inflammatory disease, due to incorrect identification of planes and a greater number of intraoperative complications.
Results obtained from a meta-analysis show that the overall conversion rate is 14.2%, with figures as high as 19.2% when it comes to colorectal cancer, and from figures obtained from controlled clinical trials, to figures as low as 8.1% when it comes to of the management of inflammatory bowel disease.
One hundred and seventy cases include, 52 (30%) for malignant and 118 (70%) for benign diseases. The main hint for surgery was diverticular ailment followed by colorectal cancer. And the most common procedure was sigmoidoscopy followed by right colectomy. Conversion rate was 8.8% (15 patients) and complete morbidity and mortality were 12%, and a smaller than 1% respectively.
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