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Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study

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Abstract

Background

Although evidence suggests that laparoscopic colectomy (LC) results in faster gastrointestinal (GI) recovery than open bowel resection, previous studies were performed at single institutions or generally not controlled for diet introduction or perioperative care, making the results difficult to interpret. A prospective, observational, multicenter study was planned to investigate GI recovery, length of hospital stay (LOS), and postoperative ileus (POI)-related morbidity after LC.

Methods

Patients scheduled to undergo LC or hand-assisted laparoscopic (HAL) bowel resection and to receive opioid-based postoperative intravenous patient-controlled analgesia were enrolled in 16 U.S. centers. The study design was similar to that for trials of alvimopan phase 3 open laparotomy bowel resection using a standardized accelerated postoperative care pathway. The primary end points were time to upper and lower GI recovery (GI-2: toleration of solid food and bowel movement) and postoperative LOS. The secondary end points included POI-related morbidity (postoperative nasogastric tube insertion or investigator-assessed POI resulting in prolonged hospital stay or readmission), conversion rate, and protocol-defined prolonged POI (GI-2 > 5 postoperative days).

Results

In this study, 148 patients received hemicolectomy by the LC (42 left and 67 right) or HAL (39 left) approach. The conversion rate was 18.8% (25.4% LC left, 17.3% HAL left, 15% LC right). The mean time to GI-2 recovery was 4.4 days, and the mean postoperative LOS was 4.9 days, neither of which varied substantially by surgical approach. Prolonged POI occurred for 15 patients (10.1%), and POI-related morbidity occurred for 17 patients (11.5%). No patients were readmitted because of POI, whereas 3 patients (2%) were readmitted for all other causes.

Conclusions

Mean GI recovery and LOS after LC were accelerated compared with those for patients in open laparotomy bowel resection clinical trials or those reported in large hospital databases (0.7 and 1.7–2.2 days, respectively). Overall POI-related morbidity was similar between the open bowel resection and LC populations, demonstrating that POI continues to present with important morbidity regardless of the surgical approach.

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References

  1. 1.

    Delaney CP, Kiran RP, Senagore AJ, Brady K, Fazio VW (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

  2. 2.

    Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs open colectomy for sigmoid diverticular disease. Dis Colon Rectum 45:1309–1314, discussion 1314–1315

  3. 3.

    Senagore AJ, Duepree HJ, Delaney CP, Dissanaike S, Brady KM, Fazio VW (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45:485–490

  4. 4.

    Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187–1192

  5. 5.

    Pokala N, Delaney CP, Kiran RP, Brady K, Senagore AJ (2007) Outcome of laparoscopic colectomy for polyps not suitable for endoscopic resection. Surg Endosc 21:400–403

  6. 6.

    Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW (2001) Laparoscopic total colectomy for acute colitis: a case-control study. Dis Colon Rectum 44:1441–1445

  7. 7.

    Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608

  8. 8.

    Milsom JW, Hammerhofer KA, Bohm B, Marcello P, Elson P, Fazio VW (2001) Prospective, randomized trial comparing laparoscopic vs conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 44:1–8, discussion 8–9

  9. 9.

    Abraham NS, Byrne CM, Young JM, Solomon MJ (2007) Meta-analysis of nonrandomized comparative studies of the short-term outcomes of laparoscopic resection for colorectal cancer. ANZ J Surg 77:508–516

  10. 10.

    Kiran RP, Delaney CP, Senagore AJ, Steel M, Garafalo T, Fazio VW (2004) Outcomes and prediction of hospital readmission after intestinal surgery. J Am Coll Surg 198:877–883

  11. 11.

    Pokala N, Delaney CP, Senagore AJ, Brady KM, Fazio VW (2005) Laparoscopic vs open total colectomy: a case-matched comparative study. Surg Endosc 19:531–535

  12. 12.

    Shore G, Gonzalez QH, Bondora A, Vickers SM (2003) Laparoscopic vs conventional ileocolectomy for primary Crohn disease. Arch Surg 138:76–79

  13. 13.

    Lordan JT, Tilney HS, Shirol S, Jourdan I, Gudgeon AM (2008) Does the laparoscopic colorectal surgery learning curve adversely affect the results of colorectal cancer resection? A 3-year prospective study in a district general hospital. Colorectal Dis 10:363–369

  14. 14.

    Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46:503–509

  15. 15.

    Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

  16. 16.

    Kaiser AM, Kang JC, Chan LS, Vukasin P, Beart RW Jr (2004) Laparoscopic-assisted vs open colectomy for colon cancer: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 14:329–334

  17. 17.

    Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91:1111–1124

  18. 18.

    Cermak K, Thill V, Simoens CH, Smets D, Ngongang CH, da Costa PM (2008) Surgical resection for colon cancer: laparoscopic assisted vs open colectomy. Hepatogastroenterology 55:412–417

  19. 19.

    Guller U, Jain N, Hervey S, Purves H, Pietrobon R (2003) Laparoscopic vs open colectomy: outcomes comparison based on large nationwide databases. Arch Surg 138:1179–1186

  20. 20.

    Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328

  21. 21.

    Buchler MW, Seiler CM, Monson JR, Flamant Y, Thompson-Fawcett MW, Byrne MM, Mortensen ER, Altman JF, Williamson R (2008) Clinical trial: alvimopan for the management of postoperative ileus after abdominal surgery: results of an international randomized, double-blind, multicentre, placebo-controlled clinical study. Aliment Pharmacol Ther 28:312–325

  22. 22.

    Delaney CP, Weese JL, Hyman NH, Bauer J, Techner L, Gabriel K, Du W, Schmidt WK, Wallin BA (2005) Phase III trial of alvimopan, a novel, peripherally acting, mu opioid antagonist, for postoperative ileus after major abdominal surgery. Dis Colon Rectum 48:1114–1125, discussion 1125–1126, author reply 1127–1129

  23. 23.

    Ludwig K, Enker WE, Delaney CP, Wolff BG, Du W, Fort JG, Cherubini M, Cucinotta J, Techner L (2008) Gastrointestinal tract recovery in patients undergoing bowel resection: results of a randomized trial of alvimopan and placebo with a standardized accelerated postoperative care pathway. Arch Surg 143:1–8

  24. 24.

    Viscusi ER, Goldstein S, Witkowski T, Andonakakis A, Jan R, Gabriel K, Du W, Techner L, Wallin B (2006) Alvimopan, a peripherally acting mu-opioid receptor antagonist, compared with placebo in postoperative ileus after major abdominal surgery: results of a randomized, double-blind, controlled study. Surg Endosc 20:64–70

  25. 25.

    Wolff BG, Michelassi F, Gerkin TM, Techner L, Gabriel K, Du W, Wallin BA (2004) Alvimopan, a novel, peripherally acting mu opioid antagonist: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial of major abdominal surgery and postoperative ileus. Ann Surg 240:728–734, discussion 734–735

  26. 26.

    Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423

  27. 27.

    Kehlet H, Dahl JB (2003) Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 362:1921–1928

  28. 28.

    Kehlet H, Wilmore DW (2005) Fast-track surgery. Br J Surg 92:3–4

  29. 29.

    Holte K, Foss NB, Andersen J, Valentiner L, Lund C, Bie P, Kehlet H (2007) Liberal or restrictive fluid administration in fast-track colonic surgery: a randomized, double-blind study. Br J Anaesth 99:500–508

  30. 30.

    Delaney CP, Senagore AJ, Viscusi ER, Wolff BG, Fort J, Du W, Techner L, Wallin B (2006) Postoperative upper and lower gastrointestinal recovery and gastrointestinal morbidity in patients undergoing bowel resection: pooled analysis of placebo data from 3 randomized controlled trials. Am J Surg 191:315–319

  31. 31.

    Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 248:189–198

  32. 32.

    Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA (2006) Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 243:143–149, discussion 150–153

  33. 33.

    Tuech JJ, Pessaux P, Rouge C, Regenet N, Bergamaschi R, Arnaud JP (2000) Laparoscopic vs open colectomy for sigmoid diverticulitis: a prospective comparative study in the elderly. Surg Endosc 14:1031–1033

  34. 34.

    Behm B, Stollman N (2003) Postoperative ileus: etiologies and interventions. Clin Gastroenterol Hepatol 1:71–80

  35. 35.

    Kehlet H (2000) Postoperative ileus. Gut 47(Suppl 4):iv85–iv86, discussion iv87

  36. 36.

    Kehlet H (2005) Preventive measures to minimize or avoid postoperative ileus. Semin Colon Rectal Surg 16:203–206

  37. 37.

    Kehlet H, Holte K (2001) Review of postoperative ileus. Am J Surg 182:3S–10S

  38. 38.

    Livingston EH, Passaro EP Jr (1990) Postoperative ileus. Dig Dis Sci 35:121–132

  39. 39.

    Williamson A, Hoggart B (2005) Pain: a review of three commonly used pain rating scales. J Clin Nurs 14:798–804

  40. 40.

    Delaney C, Kehlet H, Senagore A, Bauer AJ, Beart R, Billingham R, Coleman RL, Dozois EJ, Leslie JB, Marks J, Megibow AJ, Michelassi F, Steinbrook RA (2006) Postoperative ileus: profiles, risk factors, and definitions—a framework for optimizing surgical outcomes in patients undergoing major abdominal colorectal surgery. In: Bosker G (ed) Clinical consensus update in general surgery. Pharmatecture, LLC, Roswell, GA. http://www.clinicalwebcasts.com/updates/index.htm Accessed 10 Oct 2008

  41. 41.

    Basse L, Raskov HH, Hjort Jakobsen D, Sonne E, Billesbolle P, Hendel HW, Rosenberg J, Kehlet H (2002) Accelerated postoperative recovery programme after colonic resection improves physical performance, pulmonary function, and body composition. Br J Surg 89:446–453

  42. 42.

    Delaney CP, Fazio VW, Senagore AJ, Robinson B, Halverson AL, Remzi FH (2001) “Fast track” postoperative management protocol for patients with high comorbidity undergoing complex abdominal and pelvic colorectal surgery. Br J Surg 88:1533–1538

  43. 43.

    Kehlet H, Kennedy RH (2006) Laparoscopic colonic surgery: mission accomplished or work in progress? Colorectal Dis 8:514–517

  44. 44.

    Moraca RJ, Sheldon DG, Thirlby RC (2003) The role of epidural anesthesia and analgesia in surgical practice. Ann Surg 238:663–673

  45. 45.

    Adolor Corporation (2007) Entereg (alvimopan) Capsules for postoperative ileus. FDA Advisory Panel Briefing Document.http://www.fda.gov/ohrms/DOCKETS/ac/08/briefing/2008-4336b1-02-Adolor.pdf Accessed 10 Oct 2008

  46. 46.

    Wolff B, Weese JL, Ludwig K, Delaney C, Stamos MJ, Michelassi F, Du W, Techner L (2007) Postoperative ileus-related morbidity profile in patients treated with alvimopan after bowel resection. J Am Coll Surg 204:609–616

  47. 47.

    Delaney CP, Senagore AJ, Prasad R, Fort J, Du W, Techner L (2006) GI recovery after bowel resection (BR): literature review of laparoscopic (L) vs open (O) BR and comparison with alvimopan (ALV) phase III results. Surg Endosc 20(Suppl1):S331

  48. 48.

    Delaney CP, Chang E, Senagore AJ, Broder M (2008) Clinical outcomes and resource utilization associated with laparoscopic and open colectomy using a large national database. Ann Surg 247:819–824

  49. 49.

    Kwok A, Pernar L, Kelly M, Gu X, Goldberg J, Breen E, Bleday R (2009) Length of stay (LOS) and other outcomes after open (OC) vs laparoscopic colectomy (LAC): are they now the same? Dis Colon Rectum Suppl 52:81–82 abstract P82

  50. 50.

    Delaney CP, Wolff BG, Viscusi ER, Senagore AJ, Fort JG, Du W, Techner L, Wallin B (2007) Alvimopan, for postoperative ileus following bowel resection: a pooled analysis of phase III studies. Ann Surg 245:355–363

  51. 51.

    Delaney CP (2008) Outcome of discharge within 24 to 72 hours after laparoscopic colorectal surgery. Dis Colon Rectum 51:181–185

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Acknowledgments

Support for this study and medical editorial assistance were provided by Adolor Corporation and GlaxoSmithKline. We thank Bret A. Wing, ProEd Communications, Inc., Beachwood, Ohio, for his medical editorial assistance with this manuscript.

Author information

Correspondence to Conor P. Delaney.

Additional information

Accepted as an oral presentation at the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) 2009 meeting.

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Delaney, C.P., Marcello, P.W., Sonoda, T. et al. Gastrointestinal recovery after laparoscopic colectomy: results of a prospective, observational, multicenter study. Surg Endosc 24, 653–661 (2010). https://doi.org/10.1007/s00464-009-0652-7

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Keywords

  • Colectomy
  • Gastrointestinal recovery
  • Laparoscopic
  • Postoperative ileus