Comparison of Hypothermic Machine Preservation and Static

download report

Transcript Comparison of Hypothermic Machine Preservation and Static

A comparison of open vs laparoscopic emergency colonic
surgery; short term results from a district general hospital.
D Vijayanand , A Haq, D Roberts, & S Anwar.
Department of Coloproctology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield. U.K.
email: [email protected]
INTRODUCTION
RESULTS
Elective laparoscopic surgery has become the treatment of
choice for management of benign and malignant colonic
disease. Minimal morbidity, less postoperative pain, faster
recovery and shorter hospital stay has led to its expansion in
colonic resections. The role of emergency laparoscopic surgery
for colonic resections is not fully established yet.
Our aim was to compare the clinical outcomes of laparoscopic
versus open emergency colonic resections performed in a
district general hospital.
METHODS
Table 2: Demographics and results in general
From October 2007 to June 2011, 32 patients were identified,
who had an emergency bowel resection, performed by a
single surgeon. The patients were divided into two groups:
those with open resections (n=19) and those with laparoscopic
approach (n=13). Overall there were 18 right sided resections, 8
subtotal colectomies and 6 Hartman’s procedures.
Data was collected retrospectively and the groups were
compared with respect to indications for surgery,
demographics, operative time, blood loss, perioperative
morbidity and mortality and postoperative hospital stay. The
statistical analysis was performed with the non-parametric test
for independent samples and continuous variables; Fisher’s
exact test was used for categorical values with p<0.05
considered significant.
Table 1. Indications for surgery
Indications for the Surgery
There was no significant difference between the two groups
with respect to age, gender, co-morbidities and type of
resection performed. Median hospital stay was significantly
shorter in the laparoscopic group (8 days versus 10 days; p0.0437). Average operative time was longer in the laparoscopic
group (239 ± 31 mins versus 149 ± 12 mins; p-0.0109). Thirty day
mortality was 5% in the open and zero in the lap group.
Complication rate was higher in the open vs. laparoscopic
group (31% versus 7.6%): however this difference was not
statistically significant. Two cases in laparoscopic group were
converted to open due to tumour perforation in one and in
another access was very limited due to grossly dilated bowel.
Open
n=19
Age, years (Mean ±SEM)
55 ± 6
41 ± 7
0.1343
Male / Female %
58/42
62/38
1.0000
1
12
6
0
10
3
--
1
0
--
31 (6)
8 (1)
0.1953
Reoperation
1
0
--
Readmission
1
0
--
10 (7-42)
8 (3-12)
0.0437
ASA I
II
III
30 Day Mortality
Complications % (n)
Length of Stay, Median (Range)
(p value 0.0542)
Open (n)
Laparoscopic (n)
Inflammatory Bowel Disease
31% (6)
54% (7)
Diverticular Perforation
11% (2)
8% (1)
Bowel Obstruction secondary to
Tumour
42% (8)
23%(3)
Other
16% (3)
15% (2)
Laparoscopic
p Value
n=13
CONCLUSION
This is a non randomised comparison of laparoscopic vs. open
emergency colonic surgery. Patients in the open group were
from the earlier study period- our current practise is to
laparoscope all emergencies. Emergency laparoscopic
colectomies are feasible and safe with shorter length of stay.
The laparoscopic procedure takes longer but shows a
statistical trend toward lower morbidity.