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LAPAROSCOPIC SURGERY.

ABSTRACT: The speed of adoption and popularity of laparoscopic cholecystectomy is without precedence in modern surgical history. This has resulted in therapeutic and diagnostic laparoscopy being attempted in almost every field of surgery to substitute open surgical procedures. The list is endless. It will take time to evaluate the safety and advantages of many of these procedures as reports of controlled studies and long term follow up results are awaited. While certain procedures like gall bladder surgery and appendicectomy will establish their many fold advantages over open surgery, many other procedures like repair of hernias, radical resection of bowel for malignancy etc may fail to do so once the initial enthusiasm wanes away. Any way the concept of minimally invasive surgery is going to be a dominant factor in the surgery of this decade and one should prepare to face this fascinating challenge. Further developments in laparoscopic instruments, optical system and video imaging techniques will add to the progress and safety of laparoscopic surgical procedures in the days ahead.

SUBMITTER: Philipose KJ

PROVIDER: S-EPMC5529719 | biostudies-other | 1994 Apr

REPOSITORIES: biostudies-other

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Project description:Fast-track surgery (FTS), a multimodal rehabilitation technique, has been recommended as surgical therapy for colorectal cancer. The objective of the present study was to compare the outcomes of FTS and conventional laparoscopic surgery. This study was a blinded randomized trial. A total of 70 patients with colorectal cancer were divided into two groups and underwent laparoscopic colorectal resection. The FTS group consisted of 31 patients and the control group consisted of 39 patients. Protocols for the treatment of the FTS group included skipping pre-operative mechanical bowel preparation, early restoration of diet and early post-operative ambulation. Outcome measures, length of hospital stay, post-operative surgical stress response [C-reactive protein (CRP)] and post-operative complications were compared between the two groups. The average length of total hospital stay for the FTS and the control groups was 5.9±0.8 and 10.9±1.3 days, respectively (P<0.05), and the length of post-operative hospital stay for the FTS and control group was 4.3±0.8 and 8.0±1.1 days, respectively. (P<0.05) First flatus time for the FTS and control groups was 1.6±0.8 and 2.5±0.9 days, respectively (P<0.05). Defecation time for the FTS and control groups was 2.2±0.7 and 4.5±0.7 days, respectively (P<0.05). The time to restoration of a solid diet also showed a significant difference between the FTS and control groups (1.1±0.3 vs. 3.6±0.9 days; P<0.05). Following surgery, due to post-operative surgical stress, the two groups CRP levels increased significantly, but the levels of the FTS group were lower than those of the conventional control group (P<0.05). There was no difference in post-operative complications between the FTS and control groups. This study confirms that FTS shortens hospital stay and accelerates the recovery of bowel function without increase of post-operative complications. FTS is safe, improves post-operative recovery and is a better option than conventional laparoscopic surgery for treating colorectal cancer patients.

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LAPAROSCOPIC SURGERY.

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