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Introduction: Both laparoscopic colectomy and application of enhanced recovery program (ERP) in open colectomy have been demonstrated to enable early recovery and to shorten hospital stay. This study evaluated the impact of ERP on results of laparoscopic colectomy and comparison was made with the outcomes of patients prior to the application of ERP. Methods: An ERP was implemented in the authors' center in December 2006. Short-term outcomes of consecutive 84 patients who underwent laparoscopic colonic cancer resection 23 months before (control group) and 96 patients who were operated within 13 months; after application of ERP (ERP group) were compared. Results: Between the ERP and control groups, there was no statistical difference in patient characteristics, pathology, operating time, blood loss, conversion rate or complications. Compared to the control group, patients in the ERP group had earlier passage of flatus [2 (range: 1-5) versus 2 (range: 1-4) days after operation respectively; p = 0.03)] and a lower incidence of prolonged post-operative ileus (6% versus 0 respectively; p = 0.02). There was no difference in the hospital stay between the two groups [4 (range: 2-34) days in control group and 4 (range: 2-23) days in ERP group; p = 0.4)]. The re-admission rate was also similar (7% in control group and 5% in ERP group; p = 0.59). Conclusions: In laparoscopic colectomy for cancer, application of ERP was associated with no increase in complication rate but significant improvement of gastrointestinal function. ERP further hastened patient recovery but resulted in no difference in hospital stay. [ABSTRACT FROM AUTHOR]

Long-term outcome of patients with conversion following laparoscopic resection of colorectal cancer has seldom been reported. This study aimed to evaluate the impact of conversion on the operative outcome and survival of patients who underwent laparoscopic resection for colorectal malignancy. An analysis of a prospectively collected database of 470 patients who underwent laparoscopic colectomy between May 2000 and December 2006 was performed. The operative results and long-term outcomes of patients with conversion were compared with those with successful laparoscopic operations. The overall conversion rate to open surgery was 8.7% (41 patients). There was no difference in age, comorbid illness, location of tumor, and stage of disease between the laparoscopic and conversion groups. The most common reasons for conversion include adhesions (34.1%), tumor invasion into adjacent structures (17.1%), bulky tumor (9.8%), and uncontrolled hemorrhage (9.8%). A male preponderance was observed in the conversion group. Tumor size was significantly larger in the conversion group compared with the laparoscopic group (5 versus 4 cm, P = 0.002). Although there was no difference in the operative time between the two groups, increased perioperative blood loss (461.9 vs. 191.2 ml, P < 0.001), increased postoperative complication rate (56.1% versus 16.7%, P = 0.001) and prolonged median hospital stay (10 versus 6 days, P < 0.001) were associated with the conversion group. Consequently, patients in the conversion group were more likely to develop local recurrence (9.8% versus 2.8%, P < 0.001) with a significantly reduced cumulative cancer-free survival. The disease-free survival and the local recurrence were significantly worse by the presence of conversion in laparoscopic resection for colorectal malignancy. Adoption of a standardized operative strategy may improve the perioperative outcome after conversion. [ABSTRACT FROM AUTHOR]

The study aimed to review the etiologies of patients who underwent surgery for small bowel obstruction (SBO) and to evaluate the risk factors affecting the early postoperative outcomes. A case series of 430 patients (252 men) with a mean age of 64.5 years, who underwent 437 operations for SBO, were retrospectively reviewed. Peritoneal adhesions and hernia were the most common causes of SBO, contributing 42.3 and 26.8% of all cases, respectively. Strangulation occurred in 27.7% and caused nonviable bowel in 13.0% of obstructing episodes. Old age (age ≥ 70 years), female patient, nonadhesive obstruction, and hernia were the independent significant factors associated with bowel strangulation. The 30-day mortality was 6.5%, and the median postoperative hospital stay was 8 days. Old age, the presence of premorbid pulmonary disease, and malignant obstruction were the independent factors associated with operative mortality. The overall complication rate was 35.5%, and old age was the only significant factor associated with postoperative complications. Surgery for SBO is still associated with significant mortality and morbidity. As old age is significantly associated with an increased incidence of strangulation, operative mortality, and complications, this group of patients should be managed with extra cautions to avoid unfavorable outcome of surgery. [ABSTRACT FROM AUTHOR]

Background and aims. The value of surgery for patients with incurable colorectal cancer is controversial. This study evaluated outcomes in patients undergoing non-curative surgery for colorectal cancer and aimed to identify patients who would benefit from palliative surgery. Patients and methods. Demographics, tumour characteristics, operating details and outcomes were reviewed for 180 patients undergoing surgery for incurable colorectal cancer; palliative resection was performed in 150 cases. Seventeen patients died in the postoperative period. Risk factors for postoperative mortality and poor survival were analysed with univariate and multivariate analysis. Results. Multivariate analysis showed that operative mortality was significantly higher in patients with non-resection surgery and in those with ascites. Median survival of patients with resection was significantly longer than in those without resection (30 vs. 17 weeks). Other independent factors that were significantly associated poor survival were the presence of ascites, presence of bilobar liver metastasis and absence of chemotherapy and/or radiation therapy. Conclusion. Non-curative surgery is associated with high mortality in patients without resection and in the presence of ascites. These two factors, together with the presence of bilobar liver metastasis and the absence of chemotherapy and/or radiation therapy, are associated with poor survival. In the presence of these factors the balance between the benefit and risk of surgery should be carefully considered before decision for operative treatment. [ABSTRACT FROM AUTHOR]

Background and aims. Disturbance of bowel function is not uncommon following low anterior resection, but the effect of low anterior resection on the elderly has seldom been documented. This study investigated the functional outcome in elderly patients following low anterior resection for carcinoma of the rectum. Patients and methods. The study included 87 patients with carcinoma of middle and lower rectum who underwent curative low anterior resection with total mesorectal excision and remained alive without recurrence for at least 6 months following the resection or closure of stoma. Anorectal manometry and questionnaire survey of the patients' bowel function were performed during follow-up (median 24.1 months) to investigate the functional outcome after surgery. Results. The median number of bowel motions was 2.5 per day in both elderly and young patients. Complete continence was achieved in 71.3% of patients, with both elderly and young patients performing similarly. The most common symptoms were clustering of bowel motions and urgency, which occurred in 30.3% and 34.9% of patients respectively, regardless of age. Manometric findings were also similar between the elderly and their younger counterparts. Conclusion. Bowel function and manometric findings following low anterior resection with total mesorectal excision in the elderly are not worse than in younger patients. [ABSTRACT FROM AUTHOR]

Background and aims: Right-sided diverticulitis is rare in Western societies but is not uncommon in Asian countries. Many of the patients are operated with the presumptive diagnosis of appendicitis. This study compared the results of emergency surgery for patients with right-sided and left-sided diverticulitis. Patients and methods: Demographic data, type of operation, and surgical outcome were recorded in 60 patients who had undergone emergency surgery for colonic diverticulitis (37 right-sided, 23 left-sided). Results: Patients with right-sided disease were significantly younger (mean age 41.9 vs. 74.2), and there was a tendency to male predominance (78.4% vs. 56.5%). All patients with right-sided disease had localized peritonitis while 74% of patients with perforated left-sided diverticulitis had generalized faecal or purulent peritonitis. Mortality rates for right-sided disease and left-sided disease were 0% and 13%, respectively, and morbidity was 14.2% and 61%, respectively. Longer hospital stay was also found in patients with left-sided diverticulitis. Conclusions: There are major differences in the demographics, presentation, type of operation and outcome of patients who had emergency surgery for colonic diverticulitis, with emergency operation for left-sided diverticulitis being associated with higher mortality and morbidity. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a medical case of a patient who underwent resection of a colonic metastasis from hepatocellular carcinoma and remained disease-free for more than 5 years after the resection of metastasis.