Intra-abdominal laparoscopic hand-sewn anastomosis in colorectal surgery.

Study objective: Laparoscopic colectomies have been recently shown to be fe asible and safe, with the use of stapling devices to fashion the anastomosi s. The aim of this study was to evaluate the feasibility and safety of lapa roscopic intra-abdominal hand-sewn anastomosis. Patients and methods: Seven patients (four males and three females, mean ag e 48 years) were included. There were two ileocolic resections for recurren ce of Crohn's disease, two right colectomies (one for Crohn's disease and o ne for carcinoid tumor of the appendix), two left colectomies for diverticu litis and one segmental colectomy for sigmoid volvulus. There were: four si de-to-side anastomoses, two side-to-end anastomoses and one end-to-end anas tomosis. Anastamoses were fashioned with interrupted single layer sutures i n four cases (two ileo-colic and two colorectal anastomoses) and with singl e layer running sutures in three cases (two ileo-colic and one cole-colic a nastomoses). The specimens were retrieved by means of a plastic bag through a 3 to 5 cm long minilaparotomy in five cases and through the rectum in tw o cases. Results: Mean additional time to perform hand-sewn intracorporeal anastomos is was 90 +/- 15 min. There was no operative mortality and no intraoperativ e complications. Postoperative course was uneventful in six patients. Patie nts were started on an oral fluid diet on day 2 and discharged on day 5, ex cept for one patient with Crohn's disease who had a severe anastomotic blee ding on postoperative day 2 and who required laparotomy for hemostasis thro ugh a service colotomy with a single suture. He was discharged on day 8. Conclusion: Intra-abdominal hand-sewn anastomoses are feasible and seem rel iable. This represents a new step making laparoscopic procedures even close r to conventional techniques. This technique must be evaluated in larger se ries. (C) 2000 Editions scientifiques et medicales Elsevier SAS.