[Sources of hazards in laparoscopic colon surgery and how to avoid them]

From May 1993 to September 1994 98 patients with colon pathology were operated with the laparoscopic method. Criteria for exclusion were: patient's wish, tumor size or tumor infiltration in adjacent organs. The resection was carried out strictly according to the guidelines of open surgery. All operations were performed by two laparoscopically experienced visceral surgeons. All routine colon operations were included. The conversion rate was 13%. The rate of anastomotic leakage was 3.5% in both laparoscopic completed resections as well as in left-sided resections, which is comparable to the rate found in open resections. The rate of stenosis, showed a similar finding amounting to 3.5%. A complication subject to laparoscopic surgery occurred in one of our early cases, namely the severing of the ureter, this complication can be avoided with sufficient experience. Furthermore a portside hernia (1.2%) was due to laparoscopy and can be avoided as well by accurate suture of the trocar incisions. Initial postoperative hemorrhage (n = 4, one of which required operative revision) were no longer observed with increasing experience and careful choice of the trocar incision sites. An initially increased rate of wound infections could be reduced substantially by using a wound-protecting device during surgery. Laparoscopic colon resection is a safe method, which has a reduced rate of relevant complications in comparison to open procedures. Prerequisite for success is optimal technical equipment, an experienced and well coordinated team, and the understanding that conversion to an open procedure is not to be considered a complication.