[Laparoscopic excision of the rectum. An advanced technique or true clinical progress?]

A very high postoperative morbidity is seen after conventional open abdominoperineal excision of the rectum. The use of laparoscopic technique for this operation implies theoretical benefits, but only sparse clinical data have been published and advantages have not yet been convincingly documented. In the light of our experiences with laparoscopic colonic resections in high-risk patients and in two patients with abdominoperineal excision we propose the following perioperative regime for elderly patients undergoing rectal excision: Laparoscopic operation followed by continuous epidural analgesia, opioid-free pain treatment, restricted administration of fluids perioperatively, early enteral nutrition and enforced mobilisation as well as intensified training in colostomy care-that should already be started preoperatively. Preliminary results suggest that morbidity and the need for hospital stay can be considerably reduced by such an approach. A prospective evaluation of this strategy on the immediate postoperative results will be followed by long-term results concerning survival, local recurrence rates, distant metastases and the risk of port-site metastases.