LAPAROSCOPIC VERSUS CONVENTIONAL COLORECTAL RESECTION - A PROSPECTIVERANDOMIZED STUDY OF POSTOPERATIVE ILEUS AND EARLY POSTOPERATIVE FEEDING

Background: A shorter duration of postoperative ileus and earlier oral alimentation of patients may be a clinically relevant benefit of lapa roscopic compared with conventional colorectal resection. Patients/Met hods: A total of 60 patients were randomised to either laparoscopic (n =30) or conventional (n=30) resection of colorectal tumours. Major end points were the postoperative time to the first bowel movement and the time until oral feeding without parenteral alimentation was tolerated . Minor endpoints were the postoperative interval to the first perista lsis and first passage of flatus, the distribution of radio-opaque mar kers in abdominal radiographs on day 3 and day 5 and the incidence of postoperative vomiting. Results: Age, gender, ASA-classification and t ype of resection were comparable in the two groups. Peristalsis was fi rst noticed 26+/-9 h after laparoscopic and 38+/-17 h after convention al colorectal resection (P<0.01). First flatus occurred 50+/-19 h afte r laparoscopic and 79+/-21 h after conventional surgery (P<0.01). The incidence of postoperative vomiting was similar in both groups. Three days after surgery radio-opaque markers were found more often in the r ight colon (P<0.01) and less often in the small intestine (P<0.05) in laparoscopic compared with conventional patients. Five days after lapa roscopic surgery, more markers had reached the left colon (P<0.05). Th e first bowel movement occurred 70+/-32 h after laparoscopic and 91+/- 22 h after conventional resection (P<0.01). Oral feeding without addit ional parenteral alimentation was tolerated 3.3+/-0.7 days after lapar oscopic and 5.0+/-1.5 days after conventional surgery (P<0.01). Conclu sion: The shorter duration of postoperative ileus allows earlier resto ration of oral feeding after laparoscopic compared with conventional c olorectal resection and therefore increases quality of life immediatel y after resection of colorectal tumours.