Laparoscopic colon and rectal surgery at a VA hospital. Analysis of the first 50 cases

Laparoscopic techniques were utilized for all colon and rectal procedures undertaken by a single surgeon at the West Haven VA Hospital beginning in August of 1991.

All patients were entered into a registry, and data was gathered prospectively. This report comprises the first 50 patients. These patients were compared with 34 consecutive patients undergoing open operations during the same time period.

Overall, 33 patients (66%) were completed laparoscopically. This increased to 87% after the first 20 patients. Patients undergoing laparoscopic procedures showed significant improvement over the open and converted patients in several areas. Operative blood loss was decreased. They ate sooner (3.7 days) and required less postoperative pain medication. Major complications were less common after laparoscopic operations. Average length of stay was 8.3 days, compared with 13.9 days and 14.5 days in the converted and open groups, respectively. There was no difference in the operative time between laparoscopic and open cases; time for converted cases was significantly longer. There was no difference in lymph node counts among the three groups in patients with resections for cancer.

Laparoscopic colorectal surgery is safe and effective, although its efficacy in malignant disease is uncertain. Patients enjoy the same benefits derived from other laparoscopic procedures. Although there appears to be a longer learning curve associated with the procedure, minimally invasive techniques should become utilized more frequently for patients with colorectal disease.