[Laparoscopic abdominoperineal resection of rectum. Analysis of 18 cases]

Laparoscopic abdominoperineal resection (APR-L) represents a truly laparoscopic operation which feasibility has been demonstrated by several authors. The wish to offer a minimally invasive procedure to patients that will deal with permanent colostomy was responsible for the authors' initial experience with the method which began in 1992. Hospital charts of patients who underwent APR-L to this date were reviewed and data regarding duration of the operation, intraoperative complications, need for conversion and characteristics of the postoperative period were assessed. Seventeen patients with the diagnosis of adenocarcinoma of the low rectum and one with squamous carcinoma of the anal canal underwent APR-L in a selective basis. The duration of the procedure was between two and six hours. There were no intraoperative complications. There was one conversion due to a large uterus that impaired pelvic dissection. One patient underwent laparotomy in the postoperative course as result of abdominal distension and incipient pelvic herniation of a small bowel wall through perineal wound. There were no septic complications and mean hospital stay was seven days. Perineal hernia occurring in the late postoperative period was seen in two patients. One of these underwent surgical correction through a conventional approach. Authors conclude that APR-L is feasible with low morbidity. Rectal oncologic dissection through video-laparoscopic access seems to be preserved and the method seems to be superior to the conventional access when considering that there is no need for abdominal incision.