A Short-term Clinical Analysis Of Hand-assisted Laparoscopic Colorectal Surgery

Objective : to investigating the short-term effect and its clinical significance of the hand-assisted laparoscopic colorectal surgery.Methods:A retrospective analysis of the patients with colorectal disease received treatment in our department, from 2009.01 to 2010.12, a total of 44 patients, according to the wishes of patients were randomly divided into three groups, respectively, open surgery, laparoscopy-assisted surgery, hand-assisted laparoscopic surgery. Compare the operative time, incision length, number of lymph node dissection, postoperative intestinal function recovery time (recovery of bowel function for the first time as a standard by the anus), postoperative hospital stay, and conversion to open surgery rate, surgery complications, recurrence rate between three groups of patients. Analysis of hand-assisted laparoscopic colorectal surgery in the strengths and weaknesses, as well as hand-assisted laparoscopic technique in the clinical application of the safety and feasibility , and guidance for further assessment and initial laparoscopic surgery how physicians Select the appropriate surgical techniques.Results:All the 44 operations were successfully completed; hand-assisted laparoscopic surgery group and laparoscopy-assisted surgery group were not converted to open surgery, all surgical procedures no complications in postoperative patients recovered well. Hand-assisted laparoscopic operative time was (244.29±39.10) min and the open group (166.54±36.82) min compared to a slight increase, but the hand-assisted group was significantly better than the cut length of the open group, which is important for postoperative recovery .In terms of hand-assisted laparoscopic lymph node dissection (12.29±5.35) can be same as open surgery (14.08±7.45). Compared with the laparoscopy-assisted surgery, the operation time, number of lymph node dissection, incision length, and transfer rate, the hand-assisted laparoscopic and the laparoscopy-assisted surgery basically can achieve the same effect. In the postoperative recovery, 1 patient of the hand-assisted group was postoperative anastigmatic stricture; 2 cases of the laparoscopic-assisted group were wound infection, 1 case of incomplete intestinal obstruction; in the open surgery group ,there were 1 case of anastigmatic leakage, 1 case of gastric paralysis; all the cases were underwent conservative treatment cured. Hand-assisted laparoscopic group of patients after 2-4d, the average (3.14±0.69) d bowel function was restored to the basic exhaust backward flow of food, usually 2-3d after getting out of bed around. The open surgery group after 3-6d, the average (4.07±1.03) d to restore bowel function, usually started after 5 days out of bed, the two groups compared to hand-assisted laparoscopic group has significant postoperative recovery advantage, to a large degree of ease the burden on patients. Hand-assisted laparoscopic bowel recovery after surgery, complications, etc. compared with no significant difference , because of 2 cases in the laparoscopic-assisted group with a wound infection, the whole hospital stay after laparoscopic group (17.83±5.91) d was significantly longer than the hand-assisted laparoscopic group (11.86±1.21) d. All patients were followed up for up to 16 months, minimum of 3 months, in the open surgery group 1 patient were followed up 8 months later died of intestinal obstruction, infection, toxic shock, and the remaining cases were no recurrence.Conclusions:(1)Hand-assisted laparoscopic techniques and laparoscopic-assisted surgery can be used in clinical practice.(2)Hand-assisted laparoscopic and laparoscopic assisted surgery as compared with open surgery with less trauma and faster recovery, fewer complications and shorter hospital stay and so on.(3)Hand-assisted laparoscopic surgery has a higher safety and feasibility than the laparoscopic-assisted surgery.(4)Hand-assisted laparoscopic technique is a bridge between full laparoscopic and open surgery, it is more suitable for laparoscopic surgery as the initial physician or developing the new laparoscopic surgery.