IS COMPLETE LAPAROSCOPIC COLECTOMY SUPERIOR TO LAPAROSCOPIC ASSISTED COLECTOMY

Much debate has centered around what constitutes a true laparoscopic c olon resection. Purists argue that intracorporeal division of the mese ntery and anastomosis confer a benefit over a ''laparoscopic assisted' ' procedure. The aim of this study was to further examine this issue, Data were prospectively collected on 102 consecutive laparoscopic colo n resections. Five procedures were converted to open cases and were ex cluded from analysis. Procedures were divided into two groups. Group 1 (n = 34) consisted of complete laparoscopic procedures (no abdominal incision was made): abdominoperineal resection (3), Hartmann's reversa l (3), end colostomy (7), low anterior resection (5), proctectomy (1), sigmoid colectomy (15). Group 2 (n = 63) consisted of laparoscopic '' assisted'' procedures (i.e., an incision was made to facilitate anasto mosis, division of the mesentery, and/or specimen retrieval): Ileocoli c resection (6), restorative proctocolectomy (26), right colectomy (19 ), subtotal colectomy/end ileostomy (5), subtotal colectomy/ileorectal anastomosis (7). Length of hospitalization and duration of postoperat ive ileus were compared. A subset analysis of right colectomy (intraco rporeal mobilization and extracorporeal division of the mesentery and anastomosis) versus sigmoid colectomy (intracorporeal mobilization, di vision of the mesentery and anastomosis) was also performed. There wer e no statistically significant differences in length of hospital stay (Group 1, 7.47 +/- 2.75 days; Group 2, 7.78 +/- 5.55 days) or duration of postoperative ileus (Group 1, 3.24 +/- 1.56 days; Group 2, 3.68 +/ - 1.58 days). Similarly, in the sigmoid colectomy versus right colecto my subset analysis, there were no statistically significant difference s in length of hospital stay (sigmoid colectomy, 7.92 +/- 2.90 days; r ight colectomy, 6.40 +/- 1.50 days) or duration of postoperative ileus (sigmoid colectomy, 3.36 +/- 1.39 days; right colectomy, 3.18 +/- 1.0 7 days). Our data demonstrate that intracorporeal division of the mese ntery and anastomosis confer no advantage over the laparoscopic assist ed procedures. Data were prospectively collected on 102 consecutive la paroscopic colon resections. There were no statistically significant d ifferences in length of hospital stay or duration of postoperative ile us regardless of whether intracorporeal or extracorporeal mesenteric d ivision and anastomosis were undertaken. These data demonstrate that a completely laparoscopic procedure does not appear to offer any advant age as compared to a laparoscopic assisted one.