Purpose: It has been almost 23 years since the first laparoscopic-assisted right hemicolectomy was done when the surgeons in our institution started doing laparoscopic colorectal operations mainly for malignant diseases. The aim of this communication was to present the beginning of the laparoscopic colorectal operations in St. Naum University Clinic of Surgical Diseases in Skopje, Macedonia.
Material and methods: Twenty patients with colorectal adenocarcinoma were laparoscopically operated during the period from December 2012 to June 2013. Eleven of them were men and the rest women at a mean age of 58 years. Eight of them were rectal cancers, 3 were cancers of the rectosigmoid and the rest 9 were sigmoid adenocarcinomas. The patients were operated with 4 ports (sigmoid cancer) and 5 ports (rectum). Medial-to-lateral approach was used in all the cases. Tumour location dictated whether high or low ligation of inferior mesenteric artery (IMA) was done. Double stapler technique was applied for distal resection and anastomosis creation.
Results: Mean operating time was 315 min. There were no perioperative and early postoperative deaths. One patient was reoperated early at the same operating day for mesenteric venous bleeding. There was one case of anastomotic leakage and a laparotomy was done with temporary colostomy. One unit of blood was given to five patients due to perioperative bleeding. Mean length of hospital stay was six days. Per oral nutrition started at day 2. Mean bowel function returned after 3,5 days. There were two seromas of the minilaparotomy wounds and no cases of surgical site infection. Selected cases of sigmoid and rectal cancer were suitable for beginning of learning the laparoscopic colorectal resection technique. The long operating time was understandable due to the steep learning curve.
Conclusion: Laparoscopic colorectal surgery is safe and oncologically routine surgical method. It is widely used for many benign colorectal diseases, too. Prolonged learning of this technique should not be discouraging.
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