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Ass. Lect. Sherif Mohamed Hussien Elkaffas :: Publications:

Recent Advances in Laproscopic Colorectal Surgery
Authors: Sherif Mohammed Hussien El-Kaffas, Nabil Ahmed Ali, Hany Salah El-Din Tawfik, Hazem El-Sayed Ali
Year: 2015
Keywords: Not Available
Journal: Not Available
Volume: Not Available
Issue: Not Available
Pages: Not Available
Publisher: Not Available
Local/International: International
Paper Link: Not Available
Full paper Sherif Mohamed Hussien Elkaffas_Outcomes.pdf
Supplementary materials Not Available

Since the introduction of laparoscopic colectomy in 1991, the experience in laparoscopic bowel surgery has increased gradually. Improved laparoscopic skills and introduction of new instruments have led to broad application of laparoscopy in benign and malignant diseases.(1) Laparoscopic approaches to many benign and malignant colorectal diseases continue to expand and become more ubiquitous. Numerous studies have shown that diverticulitis, inflammatory bowel disease, and rectal prolapse can safely be managed laparoscopically. With appropriate patient and surgeon selection, many significant clinical benefits can be achieved with laparoscopic intervention. Laparoscopic resection for non-metastatic colon cancer may provide an overall survival advantage.(2) During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis is the operation of choice. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative ileoanal pouch anastomosis is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum.(3) Not all patients with diverticulitis are suitable for laparoscopic colectomy. Patients with a large mass, perforation, obstruction or very dense adhesions are more safely treated with resection by an open operation.(4) Laparoscopic resection is considered a feasible therapeutic option for patients with colorectal carcinoma. Tumor progression, difficult anatomy, intra-peritoneal adhesions, insufficient mobilization of the large intestine and difficulty in performing a sufficiently radical oncological procedure are the main obstacles. Oncological radicality is similar in both laparoscopic and conventional surgeries. Margins of resected tissue and number of removed lymph nodes are comparable . Limitation of operative trauma with a few small incisions instead of one large single incision allows faster patient mobilization and shortening of hospital stay after surgery. These patients also require less intense analgesia. Appropriate training of the operative team and possession of a harmonic scalpel or LigaSure are undoubtedly conditions for success of laparoscopic surgery of the large intestine.(5) Laparoscopic treatment of T4 colon cancer is safe and feasible and provides a similar surgical and oncologic outcome when compared with open technique.Laparoscopic multivisceral resection for colorectal cancer invading or adhering to neighboring organs is safe and feasible in selected patients.(6) Laparoscopic low anterior rectal resection (LLAR), allowing better visualization and rectal mobilization, can reduce postoperative pain and recovery, especially in the presence of a narrow pelvis, complex anatomy, or large tumors.(7) Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.(8) Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. These advantages could be particularly beneficial to high-risk patient groups, such as obese patients.(9) Complications were divided into complications that were mainly medical or surgical site infections requiring minor intervention. Then Surgical complications requiring invasive interference and mortality occurred. Length of hospital stay was directly related to the degree of the complications. Minor complications were associated with conversion and additional surgical procedures. Major complications were associated solely with conversion and rectal pathology.(10)  

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