Laparoscopic anterior lumbar fusion

Purpose: To assess the feasibility and complications of the laparoscopic ap proach to anterior lumbar fusion and to evaluate the ability of metoclopram ide in conjunction with preoperative bowel preparation and early oral feedi ng to decrease postoperative ileus and reduce the length of hospital stay. Patients and Methods: Laparoscopic anterior lumbar fusion was performed on 30 patients with persistent back pain between September 1997 and March 1999 . All patients received metoclopramide 10 mg intravenously preoperatively a nd every 6 hours postoperatively, then 10 mg orally every 8 hours for 7 day s. An experienced laparoscopic surgeon exposed the disc space, and lumbar f usion was performed by a neurosurgeon or an orthopedic surgeon. Results: One procedure in an obese patient was converted to open surgery. T he average operating time for the remaining patients was 2 hours 23 minutes . The average estimated blood loss was 75 mt. The only intraoperative compl ication was a trocar injury to the bladder. The average hospital stay was 2 .3 days. Conclusion: In properly selected patients, laparoscopic anterior lumbar fus ion with metoclopramide, preoperative bowel preparation, and early oral fee ding results in a short hospital stay and yields better cosmetic results th an traditional surgery.