[Laparoscopic colon surgery in the regional hospital: initial experiences after 65 interventions]

321 colorectal operations have been performed in our institution in a 4-year period from 1992 to 1996. They included 65 laparoscopic interventions for benign disease or for palliative treatment of malignancy. 40 patients underwent low anterior resections, mostly for diverticular disease. 11 right hemicolectomies, 3 left hemicolectomies, 1 total colectomy and 7 rectopexies (6 with sigmoid resection) were performed. 3 patients with advanced malignant disease underwent colostomy. There was a conversion rate of 26%, largely due to adhesions or unclear anatomy, decreasing with increasing experience. One trokar-injury of a major vessel required immediate conversion to laparotomy. 2 reoperations were performed, for an anastomotic leakage after low anterior resection and an incarcerated port-site-hernia respectively. A rather high rate of wound infections (27%) was reduced to 15% by modifying the technique for retrieval of the specimen. The median postoperative hospital stay was 11.6 days. The trend towards shorter hospital stay and recovery should not result in uncritical use of laparoscopy in colon surgery, in an attempt to meet the rising demand for less postoperative pain and shorter hospital stay. This criticism mainly applies to tumor surgery, where laparoscopic procedures are indicated in our institution only for palliative treatment.