PROSPECTIVE ANALYSIS OF 40 INITIAL LAPAROSCOPIC COLORECTAL RESECTIONS- A PLEA FOR A RANDOMIZED TRIAL

The experience reported herein is on our initial 40 cases of laparosco pic-assisted (LA) colorectal resection that were prospectively evaluat ed. The operations were performed for colonic tumors of the right segm ent (n = 4), sigmoid (n = 11), or rectum (n = 7), diverticular disease (n = 17), and chronic constipation (n = 1). Among 22 tumors, 11 were malignant. The operative procedures were 4 right hemicolectomies, 28 s egmental left colectomies, 5 anterior resections, 2 abdominoperineal r esections, and 1 total colectomy. Thirty-one patients (77.5%) had a su ccessfully completed LA resection. The reasons for conversion in the m ajority of the cases (66.6%) were difficulties in dissection. In the e ntirely LA procedures, the mean flatus postoperative day was 3, the me an postoperative hospitalization was 10.7 days, and there were 8 compl ications (25%) in 7 patients. Two patients were reoperated 2 add 3 mon ths later for adhesion and ischemic stenosis of the colon above the an astomosis, There was 1 death in the LA group (3.2%). The length of ope rative specimen was 19.6 cm, and the mean number of resected lymph nod e was six. In contrast to laparoscopic biliary surgery, the benefits o f LA colorectal surgery are not obvious. A randomized trial comparing LA and open colorectal resection must be carried out.