Laparoscopic colectomy compares favorably with colectomy by laparotomy forreduction of postoperative ileus

PURPOSE: The aim of this study was to compare the length of postoperative i leus in patients undergoing colectomy by either laparotomy or laparoscopy. METHODS: A total of 166 patients were studied. These patients were divided into two groups: Group 1, in which colectomy was done laparoscopically, and Group 2, consisting of patients undergoing laparotomy. Both groups contain ed 83 patients who were matched for disease severity, indications for surge ry, and procedure. Indications for surgery included sigmoid diverticulitis in 12 (14 percent) patients, polyps in 22 (27 percent), Crohn's disease in 21 (25 percent), colorectal cancer in 11 (13 percent), stoma reversal in 8 (10 percent), rectal prolapse in 3 (4 percent), and other indications in 6 (7 percent) in each group. Operations were colectomy with anastomosis (42 i leocolic, 26 colorectal, 6 colocolic, 4 ileorectal, and 2 ileal J pouch) or without anastomosis (3 abdominoperineal resections) performed by the same surgeons during the same time period (January 1993 to October 1996). The na sogastric tube was removed from all patients immediately after surgery in b oth groups. All patients received a clear liquid diet on the first postoper ative day, followed by a regular diet as tolerated. The nasogastric tube wa s reinserted if two or more episodes of emesis of more than 200 mi occurred in the absence of bowel movement. Patients were discharged from the hospit al when tolerating a regular diet without evidence of ileus. Statistical an alysis was performed using unpaired t-test and Fisher's exact probability t est. RESULTS: The male-to-female ratio was 38 to 45 in both groups. A total of 10 (12 percent) and 23 (28 percent) patients in Group 1 and Group 2 had emesis (P = 0.02), and the rate of nasogastric tube reinsertion was 5 (6 p ercent) and 13 (16 percent), respectively (P > 0.05). There were significan t differences between Groups 1 and 2 relative to the lengths of ileus (3.5 +/- 1.3 vs. 5.4 +/- 1.7 days, respectively, P < 0.001), hospitalization (6. 6 +/- 3.3 vs. 8.1 +/- 2.5 days, respectively; P < 0.002), and operative tim e (170 +/- 60 vs. 114 +/- 46 minutes, respectively; P < 0.001). The morbidi ty rate was 16 (19.2 percent) and 18 (21.6 percent) in the laparoscopy and laparotomy groups, respectively. CONCLUSIONS: Although early oral intake is safe and can be tolerated by 84 percent of patients after colectomy by lap arotomy, laparoscopic colectomy reduced the lengths of both postoperative i leus and hospitalization.