Unit:
Κατεύθυνση Ελάχιστα Επεμβατική Χειρουργική, Ρομποτική Χειρουργική και Τηλεχειρουργική με εξειδίκευση στη Γενική ΧειρουργικήLibrary of the School of Health Sciences
Author:
Papazoglou Antonia
Supervisors info:
Δ. Δημητρούλης, Αναπλ.Καθηγητής, Ιατρική , ΕΚΠΑ
Ν. Νικητέας, Καθηγητής, Ιατρική, ΕΚΠΑ
Ι. Γκρινιάτσος, Αναπλ. Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Minimally invasive surgery for the treatment of benign colorectal diseases: a systematic review
Translated title:
Minimally invasive surgery for the treatment of benign colorectal diseases: a systematic review
Summary:
The last two decades the interest of the surgical community for minimally invasive techniques is constantly growing. Nevertheless, the use of laparoscopy and other novel techniques for benign colorectal conditions has not been fully investigated.
For the time being, laparoscopy should be offered as method of choice to all patients with uncomplicated Crohn’s disease, especially if it is limited to distal ileum and cecum, provided that the required equipment and expertise are available. Laparoscopy cannot be considered standard of care for penetrating, fistulising, recurrent and other complicated forms of Crohn’s disease. On the other hand, neither of these conditions is contraindication for laparoscopy (Rosman et al) and more data and further research is needed to come to solid conclusions on this issue.
The data on the use of minimally invasive techniques for the treatment of ulcerative colitis are limited. Nevertheless, it is clear that laparoscopy is associated with reduced morbidity and mortality rates compared to open procedures and it should be considered standard of care treatment for ulcerative colitis. It has better outcomes as far as the early postoperative period is concerned, while the long-term functional results are similar to the open approach.
The role of laparoscopy in the treatment of diverticular disease remains unclear for both emergency and elective operations. Minimally invasive surgery for these patients seems feasible and safe and multiple RCTs show some important benefits. Further studies regarding quality of life may set solid indications for laparoscopic sigmoidectomy. There is reluctance in the use of laparoscopic techniques in cases of complicated diverticulitis but there is no clear contraindication, since the conversion rates are similar. Perhaps the therapeutic decisions should not only be based on the clinical and endoscopic findings. Computed Tomography prior to elective operations may help choosing the most suitable surgical approach.
As far as appendicitis is concerned, laparoscopic approach is not suitable for all cases. An effort should be made to select those patients that may benefit from this minimally invasive technique, regarding bowel obstruction and other parameters of postoperative complications and recovery.
Fistulae present a complicated condition and their treatment is very challenging. However, various minimally invasive procedures have been attempted with encouraging results. For the time being the indications for their use should be considered on individualized basis.
Multiport laparoscopic and SILS procedures are a safe and feasible option for patients with malrotation and sigmoid volvulus. It is a new, promising method that needs to be further investigated.
The surgical treatment of constipation is a challenging issue, as the operations required are extensive and complex. Nevertheless, laparoscopic approach is a safe and feasible option for experienced surgeons.
Patients suffering from rectal prolapse are usually of old age and impaired health. Abdominal procedures are considered very stressful for these frail patients’ population. On the other hand, perineal operations are associated with high recurrence rate. Minimally invasive techniques such as robotic and laparoscopic surgery for performing the abdominal operations may offer an ideal choice for these patients. For the time being, no clear guidelines have been set and further research is required.
This review confirms that the introduction of laparoscopic and other minimally invasive techniques in the treatment of benign colorectal diseases is a constantly evolving and developing field that has not yet been fully investigated.
Keywords:
Minimally invasive surgery, Benign colorectal diseases
Number of references:
138
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