Laparoscope-assisted Colectomy for Patients with Acute Abdomen

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  • 腹部救急疾患に対する低侵襲手術　　急性腹症に対する腹腔鏡補助下大腸手術の応用

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Abstract

Based on 3 years of experience performing laparoscope-assisted colectomies (LAC), we expanded the indications for performing this precedure to include patients with acute abdomen as of April 2002. Among the 241 patients who underwent LAC over a period of 6 years and 7 months, 23 patients were treated because of an acute abdomen, including 20 cases of intestinal obstruction and 3 cases of peritonitis. The indications for LAC in patients with acute abdomen were regarded as localized peritonitis or intestinal obstruction that had been sufficiently decompressed before operation to provide a working space for the LAC. The patients who underwent an emergency LAC were retrospectively compared with 51 cases of colonic acute abdomen treated using open surgery and 217 cases of elective LAC. The proportion of patients who received a colostomy, the amount of intraoperative bleeding, and the number of postoperative complications were significantly lower in the emergency LAC group than in the open surgery group. Though 19 complications occurred in the open surgery group, mild wound infection was seen in only one case and no operative mortalities occurred in the emergency LAC group. The conversion rate to open surgery and the incidence of complications after emergency LAC were similar to the rates for elective LAC. Patients with colon cancers were included in the emergency LAC group all the patients survived without recurrence during a median postoperative period of 22 months. LAC is useful in select cases of acute abdomen.

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