Introduction:
Laparoscopic sigmoid colectomy, despite its recognized advantages, has faced slow adoption due to perceived challenges like a steep learning curve, longer operative times, and increased costs. This article delves into the significant outcomes achieved through the standardization of both intraoperative and postoperative procedures in our department for laparoscopic sigmoid colectomy. A standardized postoperative care plan is crucial in ensuring optimal recovery and minimizing complications following surgical interventions.
Methods:
We conducted an analysis of a consecutive series of patients who underwent laparoscopic sigmoid colectomy from March 1999 to December 2001 at the Cleveland Clinic Foundation. The study included patients requiring sigmoid or rectosigmoid resection for various colonic pathologies. Exclusion criteria for attempted laparoscopic surgery were a body mass index exceeding 35 and a history of major abdominal surgeries (excluding hysterectomy, cholecystectomy, or appendectomy). Data collection encompassed age, gender, surgical indication, ASA class, BMI, operative duration, hospital stay length, complications, mortality, and 30-day readmission rates. The standardized operative steps included: 1) open umbilical port insertion; 2) placement of three operating ports; 3) vascular pedicle dissection/division after left ureter identification; 4) sigmoid and descending colon mobilization; 5) rectal mobilization/division; 6) specimen exteriorization; and 7) circular stapled anastomosis. Standardized instrumentation was used throughout. Conversion to open surgery occurred when a procedural step could not be completed efficiently laparoscopically. Crucially, a standardized perioperative care plan was implemented for all patients, focusing on optimizing recovery after diagnosis and surgery.
Results:
Between March 1999 and December 2001, the primary surgeon performed 207 sigmoid colectomies, with 181 (87.4%) attempted laparoscopically and 22 (12.1%) requiring conversion. Indications for laparoscopic sigmoid colectomy included diverticular disease (115), colonic neoplasia (32), prolapse (14), endometriosis (10), and other conditions (10). The patient demographics showed a male/female ratio of 85:96, and a mean BMI of 27.3 +/- 5.6. The mean operative time was 119 +/- 35 minutes. The mean length of hospital stay was notably short at 2.9 +/- 1.2 days for completed laparoscopic cases and 6.4 +/- 1.4 days for converted cases, highlighting the impact of efficient procedures and postoperative care. Anastomotic leaks occurred in only two patients (1.1%), with one mortality due to multisystem organ failure, resulting in a low operative mortality rate of 0.6%. The overall complication rate was 6.6%, and the 30-day readmission rate was 8%. These results underscore the safety and efficacy of the standardized approach, reflecting positively on postoperative diagnosis and care effectiveness.
Conclusion:
Our findings demonstrate that a structured approach to laparoscopic sigmoid colectomy, incorporating a standardized postoperative care plan, provides surgeons with objective benchmarks for operative progress. This standardization effectively limits prolonged operative times without increasing conversion rates and optimizes resource utilization. This standardized approach serves as a valuable framework for teaching and mastering laparoscopic sigmoid colectomy, potentially shortening the learning curve and enhancing patient outcomes. The implementation of a “Standardized Postoperative Care Plan Diagnosis 6” equivalent, focusing on streamlined processes and consistent care, is instrumental in achieving these improved results in laparoscopic sigmoid colectomy.
