Laparoscopic total abdominal colectomy in the acute setting

Michael R. Marohn, Eric J. Hanly, Kevin McKenna, Carmen R. Varin

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

We report results from a single surgeon's 10-year team experience with laparoscopic total abdominal colectomy. We review our series, which includes a large subgroup of ill, high-risk patients with acute colitis requiring urgent surgery. From 1993 to 2003, we performed 65 laparoscopic total abdominal colectomies. All patients referred for total abdominal colectomy were offered the laparoscopic approach. We prospectively collected the following data on all patients: demographics, surgical indications, preoperative status, duration of surgery, intraoperative blood loss, operative complications, length of stay, subsequent operations, patient satisfaction, and lessons learned from our team experience. Preoperative diagnoses included ulcerative colitis (n = 55), Crohn's colitis (n = 3), colonic inertia (n = 4), and familial adenomatous polyposis (n = 3). Among the patients with inflammatory bowel disease, 70% of cases were performed on ill patients, refractory to medical management, requiring urgent surgery. This subgroup was managed with laparoscopic total abdominal colectomy and Brooke ileostomy, with ileoanal pouch anastomosis deferred. Operative times were long, ranging from 6 to 11 hours. Mean intraoperative blood loss was 200 ml. Mean length of stay was 4.3 days and ranged from 2 to 13 days. There were no conversions to open surgery and there were no deaths. Complications occurred in 12% of patients and included intra-abdominal abscess (n = 2), wound infection (n = 3), stoma stenosis (n = 1), and incisional hernia (n = 2). Postoperative patient satisfaction was high. Subsequent operations, including restorative proctectomy, were also performed laparoscopically. Laparoscopic total abdominal colectomy is technically challenging and requires a team approach but offers patients significant benefit in length of stay and surgical recovery. This operation can be effectively used with minimal morbidity in difficult, ill patients requiring urgent surgery.

Original languageEnglish (US)
Pages (from-to)881-887
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume9
Issue number7
DOIs
StatePublished - Sep 1 2005

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Colectomy
Length of Stay
Colitis
Patient Satisfaction
Conversion to Open Surgery
Abdominal Abscess
Colonic Pouches
Ileostomy
Adenomatous Polyposis Coli
Wound Infection
Constipation
Operative Time
Ulcerative Colitis
Inflammatory Bowel Diseases
Pathologic Constriction
Demography
Morbidity

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

Marohn, Michael R. ; Hanly, Eric J. ; McKenna, Kevin ; Varin, Carmen R. / Laparoscopic total abdominal colectomy in the acute setting. In: Journal of Gastrointestinal Surgery. 2005 ; Vol. 9, No. 7. pp. 881-887.
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Laparoscopic total abdominal colectomy in the acute setting. / Marohn, Michael R.; Hanly, Eric J.; McKenna, Kevin; Varin, Carmen R.

In: Journal of Gastrointestinal Surgery, Vol. 9, No. 7, 01.09.2005, p. 881-887.

Research output: Contribution to journalArticle

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