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Laparoscopic total abdominal colectomy in the acute setting.
Michael R Marohn1, Eric J Hanly, Kevin J McKenna
1Department of Surgery, Uniformed Services University, Bethesda, and Malcolm Grow USAF Medical Center, Andrews Air Force Base, Maryland, USA. mmarohn1@jhmi.edu
Summary
Laparoscopic total abdominal colectomy is a complex procedure that can be safely performed in high-risk patients, including those with acute colitis. This approach offers benefits in recovery and length of stay with minimal complications.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Laparoscopic total abdominal colectomy (LTAC) is an advanced surgical technique.
- A significant subgroup of patients requiring LTAC present with acute colitis, often being high-risk and requiring urgent intervention.
Purpose of the Study:
- To evaluate the outcomes of a single surgeon's 10-year team experience with LTAC.
- To assess the feasibility and safety of LTAC in a cohort including critically ill patients with acute colitis.
Main Methods:
- A prospective review of 65 LTAC procedures performed between 1993 and 2003.
- Data collection included demographics, indications, preoperative status, operative details, complications, length of stay, and patient satisfaction.
Main Results:
- LTAC was performed for ulcerative colitis (n=55), Crohn's colitis (n=3), colonic inertia (n=4), and familial adenomatous polyposis (n=3).
- 70% of inflammatory bowel disease patients were critically ill and required urgent surgery.
- Mean operative time was 6-11 hours, mean blood loss 200 ml, and mean length of stay 4.3 days.
- No conversions to open surgery or deaths occurred; 12% complication rate (abscess, wound infection, stoma stenosis, hernia).
- High patient satisfaction and successful laparoscopic completion of subsequent restorative procedures were noted.
Conclusions:
- LTAC is technically demanding, requiring a dedicated team approach.
- This approach offers significant benefits in terms of length of stay and surgical recovery.
- LTAC can be safely and effectively employed with minimal morbidity, even in complex, critically ill patients requiring urgent colectomy.