The Outcome of Early Experience of Laparoscopic Colorectal Surgery at Armed Forces Hospital

Maj Gen C K Jakhmola, Wg Cdr V Trehan , Col S S Kumar , Wg Cdr Ameet Kumar

laparoscopic colorectal surgery for colorectal malignancy is still under-utilized among various surgeons. A steep learning curve is one of the most common cause of its restricted acceptance.

 Aim: To determine the probability of laparoscopic colorectal surgery in a single institution by implementing a well standardized protocol based operative technique.

Methods & Materials:  92 patients underwent laparoscopically colorectal surgery for colorectal malignancies between 2008 to 2016 were included. All the procedures were performed by trained gastrointestinal surgeons by following protocol based operative technique. Procedures were performed according to the principle of complete mesocolic or total mesorectal excision (TME). Postoperatively fast track recovery programme was followed and recovery parameters, morbidity and mortality have been assessed.

Results: Type of resections: 31 patients underwent  right colonic  resections, 17 low anterior resection with TME, 14 left colonic  resections, 13 anterior resection, 11 underwent abdominoperineal resection (APR) , 6 patients underwent total panproctocolectomy with ileal pouch anal-anastomosis (IPAA).  Mean operative time: 250 min; Mean number of lymph-nodes removed was 18.2. Eight cases were converted to open procedure. Overall morbidity and  mortality was 31.5% and  2.17% respectively. The major morbidity, as defined by Clavien Dindoe grade  III or higher was  9.78%.

Conclusion: Laparoscopic colorectal surgery is safe and leads to good results in terms of recovery parameters and immediate outcomes. Stringent criteria of patient selection, identical preoperative workup and protocol based surgical technique leads to shortening of learning curve and improved outcome.