Hand-Assisted Laparoscopic Colectomy for Complicated Colorectal Disease in Emergency Settings.

Abstract

Background and objectives: The safety and effectiveness of laparoscopic approaches for emergency colorectal surgery are not yet fully established, though their use is increasing with studies reporting laparoscopic colectomy is safe and feasible for appropriately selected patients. Hand-assisted laparoscopy (HAL) involves inserting one hand into the abdomen through a small incision, offering advantages that may facilitate laparoscopic procedures in emergencies. This study reports our experience with emergency HAL colectomy.

Methods: This was a retrospective review of consecutive colorectal emergency cases treated with HAL colectomy in a tertiary referral center. Patient demographics, indications for surgery, operative details, and postoperative outcomes were analyzed. Survival rates were calculated for cases with malignancy.

Results: From February 2015 to July 2019, HAL was applied to all emergency colectomy cases in patients with an American Society of Anesthesiologists (ASA) score of I-III. A total of 50 patients treated with HAL colectomy for complicated colorectal disease were reviewed. Twenty-five patients (50%) had an obstruction which required an intraoperative decompression procedure or intraoperative antegrade colonic irrigation. Thirty-eight patients (76%) had perforation. There were 2 cases of open conversion (4%). The median duration of the operation was 160 minutes. The median amount of estimated blood loss was 250 mL. The median time of postoperative stay was 12 days. The postoperative complication rate associated with the operation was 26% (13/50). There were 2 postoperative mortalities.

Conclusion: HAL appears to be a feasible option in emergency colectomy for ASA I-III patients and may be beneficial in specific surgical practice contexts.