Introduction:
Laparoscopic sigmoid colectomy, while offering numerous advantages, has faced slower adoption due to perceived challenges in learning and concerns about extended operative times and costs. This article delves into the outcomes achieved through the implementation of a standardized approach encompassing both intraoperative and postoperative procedures for laparoscopic sigmoid colectomy within our department. Our aim was to assess the impact of this standardization on surgical efficiency and patient recovery.
Methods:
We conducted a retrospective analysis of consecutive patients undergoing laparoscopic sigmoid colectomy between March 1999 and December 2001 at the Cleveland Clinic Foundation. The study included patients requiring sigmoid or rectosigmoid resection for various colonic pathologies. Exclusion criteria were limited to patients with a body mass index exceeding 35 and those with a history of major abdominal surgeries, excluding hysterectomy, cholecystectomy, or appendectomy. Data collection encompassed patient demographics, surgical indications, ASA class, BMI, operative duration, hospital stay length, complications, mortality, and 30-day readmission rates. The standardized laparoscopic sigmoid colectomy procedure followed a precise sequence: 1) open umbilical port insertion; 2) placement of three operating ports; 3) vascular pedicle dissection and division post left ureter identification; 4) sigmoid and descending colon mobilization; 5) rectal mobilization and division; 6) specimen exteriorization; and 7) circular stapled anastomosis. Instrumentation was also standardized for each procedure. Conversion to open surgery was considered if a procedural step could not be completed efficiently laparoscopically. Crucially, a standardized postoperative care plan diagnosis 10 was uniformly applied to all patients to optimize recovery and outcome criteria.
Results:
From March 1999 to December 2001, a single primary surgeon performed 207 sigmoid colectomies. Of these, 181 (87.4%) were attempted laparoscopically, with a conversion rate of 12.1% (22 cases). Indications for laparoscopic procedures included diverticular disease (115), colonic neoplasia (32), prolapse (14), endometriosis (10), and other conditions (10). The patient cohort consisted of 85 males and 96 females, with a mean BMI of 27.3 +/- 5.6. The average operative time was 119 +/- 35 minutes. Completed laparoscopic cases had a mean hospital stay of 2.9 +/- 1.2 days, significantly shorter than converted cases at 6.4 +/- 1.4 days. Anastomotic leaks occurred in 1.1% of patients (two cases), with one mortality due to multisystem organ failure, resulting in a 0.6% operative mortality rate. The overall complication rate was 6.6%, and the 30-day readmission rate was 8%. These results highlight the effectiveness of the standardized postoperative care plan diagnosis 10 in achieving favorable outcome criteria.
Conclusion:
Our findings demonstrate that a standardized approach to laparoscopic sigmoid colectomy, incorporating a standardized postoperative care plan diagnosis 10, provides surgeons with objective benchmarks for operative progress. This structured methodology effectively limits prolonged operative times without increasing conversion rates and optimizes resource utilization. Furthermore, this standardized protocol serves as a valuable framework for teaching and mastering laparoscopic sigmoid colectomy, potentially shortening the learning curve and ultimately enhancing patient outcomes. The implementation of a standardized postoperative care plan diagnosis 10 is crucial for achieving consistent and improved outcome criteria in laparoscopic sigmoid colectomy.
