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Intraoperative Difficulties and the Reasons for Conversion in Patients Treated with Laparoscopic Colorectal Tumors

100%
Tarnowski W., Uryszek M., Grous A., Dib N.
Polish Journal of Surgery
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2012
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vol. 84
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issue 7
352-357
EN
The aim of the study was an evaluation of conversion causes and intraoperative difficulties in patients treated with laparoscopic surgery due to colorectal tumours on the basis of authors' own material.Material and methods. in the period 2009-2012 160 patients were operated on because of large bowel cancer, 79 women and 81 men. Average age of patients was 66 years. The conversion was recognized as desuflation of peritoneal cavity, trocars removal and making laparotomy.Results. The conversion was made in 22 cases (13,7%). More in men (16.1%) than in women. The conversion was made twice as likely in T3 and T4 tumors than in T1 and T2.Conclusions. The main cause of conversion in laparoscopic operations of colorectal cancer is local tumor progression.
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Laparoscopic Abdominoperineal Resection Of The Rectum – How Is It Done; Initial Results

88%
Grous A., Uryszek M., Ciesielski A., Dib N., Tarnowski W.
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vol. 85
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issue 10
569-575
EN
The abdominoperineal resection of the rectum is a classical operation performed in case of patients diagnosed with rectal cancer. The development of laparoscopic techniques in recent years, introduced yet another method of treatment, considering patients with rectal cancer- laparoscopic abdominoperineal resection of the rectum. The aim of the study was to present initial treatment results considering the above-mentioned patients. Material and methods. The study group comprised 25 patients (16 male and 9 female) diagnosed with low-rectal cancer, subjected to surgery by means of the above-mentioned method. Mean patient age amounted to 66 years. Three (12%) patients required conversion to classical surgery (laparotomy), while one patient required reoperation, due to presacral vascular bleeding. Complications were observed in 10 (40%) patients. Average hospitalization was 7 days. In case of all patients the radial margin was negative, and mean number of removed lymph nodes amounted to 9.6. Mortality was not observed during the perioperative period. Due to the initial character of the study analysis (mean observation period in case of 68% of patients was shorter than 2 years), oncological results were not subject to evaluation. Conclusions. Laparoscopic abdominoperineal resections are considered as technically difficult operations, requiring significant experience of the operating team. However, they enable the patient to take advantage of the many assets of minimally invasive surgery, with comparable rates of postoperative complications.
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Laparoscopically Assisted Ileo-Colonic Resection in Patients with Crohn’s Disease – Preliminary Report

76%
Borycka-Kiciak K., Dib N., Janaszek Ł., Sołtysiak Ł., Bukowicka B., Tarnowski W.
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vol. 85
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issue 9
505-510
EN
Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn’s disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn’s disease. Material and methods. 82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow‑up. Results. The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25±6 vs 43±9, p<0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p=0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn’s disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients. Conclusions. Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn’s disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.
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