Laparoscopic colon surgery is just as good as open surgery for emergencies
Research Activities, August 2009, No. 348
Most patients undergoing elective surgery of the colon are operated on with a minimally invasive technique called laparoscopy. In fact, it is now the gold standard of care in nonemergency cases. However, very little is known about how this approach compares with open surgery in emergency and urgent situations. A new study finds that there are advantages to laparoscopic surgery for these emergency cases, provided the surgeon is skilled in this approach. In laparoscopy, a laparoscope is inserted through a small incision in the abdomen to view internal organs. Surgical instruments are also inserted through the same small incision to perform the operation.
In this study, the researchers used a database to identify 94 patients who underwent emergency colon surgery over an approximately 3-year period. A total of 42 patients underwent laparoscopic surgery. Another 25 patients who qualified for this approach received open surgery instead. The mean surgical time was 21 minutes less for laparoscopic patients, who lost significantly less blood (118 mL) compared with open surgery patients (205 ml). They also had shorter hospital stays of 8 days compared with 11 days for patients undergoing the open procedure. In addition, laparoscopic patients spent less time in intensive care after surgery. Mortality rates were similar between both groups.
According to the researchers, more studies are needed to evaluate the role of laparoscopic surgery in certain emergency situations. There is a steep learning curve surgeons must overcome before mastering this type of surgical technique. Hence, any laparoscopic emergency procedure must be performed by surgeons highly skilled in this area of surgery. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00059).
See "Emergency laparoscopic colectomy: Does it measure up to open?" by Jonah J. Stulberg, M.P.H., Brad J. Champagne, M.D., Zhen Fan, M.D., and others, in the March 2009 The American Journal of Surgery 197, pp. 296-301.