Preliminary Experience with Laparoscopic Colectomy: Comparison with Conventional Colectomy

Kang, Won Kyung; Kim, Jun Gi; Chin, Hyung Min; Lee, Yun Bok; Park, Woo Bae; Chun, Chung Soo

Abstract

Laparoscopic techniques are being applied to the surgical management of the colorectal disease. Comparing our twenty-month experience in laparoscopic colectomy with that of the conventional (open) colectomy, we evaluate the efficacy and the safety of laparoscopic operations in colorectal disease. From April 1994 to December 1995, thirty-five patients underwent a colorectal surgery at St. Vincent's Hospital, The Catholic University of Korea, College of Medicine. Nineteen patients (5 males and 14 females; mean age 54.8 years) were included in the laparoscopic group and fourteen patients (5 males and 9 females; mean age 50.9) were included in the open group. Two conversion cases were excepted due to unfitness for comparison. Malignancy were 15 cases in the laparoscopic group and 9 cases in the open group. To estimate the general advantage of laparoscopic surgery, we compared durations of wound pain and ileus, postoperative hospital stays, and operative time between two groups. Then surgical margins and numbers of lymph nodes harvested were compared between two groups for an evaluation of radical curability of malignant disease. The operative procedures of two groups included abdominoperineal resection, anterior resection, low anterior resection, sigmoid colectomy, right hemicolectomy, and Hartmann's procedure. The conversion rate of laparoscopic colectomy was 9.5 % (2 of 21). In the laparoscopic group, we experienced some advantages in duration of pain and ileus, and postoperative hospital stays, even though there was no statistical significance. Comparable surgical margins and numbers of lymph nodes harvested proved the laparoscopic procedures to be worthy of radical surgery. Between the two groups, morbidity and mortality showed no difference. Although the operative time of the laparoscopic group was longer than that of the open group, it can be decreased with more experience, development of better instruments, and the specialization. Even if we require a long-term survival rate, our data suggest that the laparoscopic colectomy can be accomplished effectively and safely with the accumulation of experience and the advancement of equipments.