Our Summary

This research paper is about a study that compares traditional surgery and minimally invasive techniques for closing up the end of the colon after a specific type of bowel surgery called Hartmann’s procedure. The researchers looked at data from various medical databases, considering studies that compared open surgery with minimally invasive procedures.

The minimally invasive techniques that were considered in this study included conventional laparoscopy, robotic surgery, and single-port laparoscopy. The main outcomes that the researchers were interested in were the rate of complications after surgery, the rate of failure of the join in the bowel, the rate of wound complications, and death rates. They also looked at details about the surgery and its outcomes.

In total, the researchers looked at data from 13,740 patients from 26 different studies. They found no significant differences in things like age, body mass index, and the proportion of high-risk patients between the two groups.

However, the minimally invasive surgery group had significantly better results when it came to complications after surgery, the length of hospital stay, and the rate of hernias that occur at the site of the incision.

Based on these findings, the researchers suggest that minimally invasive surgery should be considered for Hartmann’s reversal, if it’s technically possible. However, they also note that the evidence available is of low quality, so they can’t make definitive conclusions.

FAQs

  1. What is the difference between conventional surgery and minimally invasive surgery in Hartmann’s reversal procedures?
  2. What are the primary outcomes evaluated in the comparative studies between open and minimally invasive procedures?
  3. Does the current medical literature suggest one type of surgery over the other for Hartmann’s reversal procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about proctectomy is to discuss with their healthcare provider about the possibility of minimally invasive surgery options such as laparoscopy, robotic surgery, or single-port laparoscopy. These techniques have been shown to result in lower postoperative morbidity, shorter hospital stays, and lower rates of complications such as incisional hernias compared to conventional open surgery. It is important to have a thorough discussion with your healthcare provider to determine the best approach for your individual case.

Suitable For

Patients who are typically recommended proctectomy include those with conditions such as rectal cancer, ulcerative colitis, Crohn’s disease, familial polyposis, and other conditions that affect the rectum and colon. These patients may require a proctectomy in order to remove the diseased portion of the colon and rectum and improve their quality of life.

Timeline

Before proctectomy:

  • Patient presents with symptoms such as rectal bleeding, changes in bowel habits, or abdominal pain
  • Patient undergoes diagnostic tests such as colonoscopy, CT scans, or MRI to confirm diagnosis
  • Patient consults with a colorectal surgeon to discuss treatment options
  • Patient undergoes preoperative preparations such as bowel cleansing and dietary restrictions
  • Patient undergoes proctectomy surgery which may be performed using conventional celiotomy or minimally invasive techniques

After proctectomy:

  • Patient is monitored in the recovery room for any immediate postoperative complications
  • Patient is given pain medication and antibiotics to prevent infection
  • Patient may have a temporary colostomy or ileostomy to allow the bowel to heal
  • Patient undergoes follow-up appointments with the surgeon to monitor healing and remove any drainage tubes
  • Patient gradually resumes normal activities and diet as instructed by the healthcare team
  • Patient may undergo additional treatments such as chemotherapy or radiation therapy if the proctectomy was performed for cancer
  • Patient may experience long-term side effects such as changes in bowel habits or sexual dysfunction
  • Patient undergoes colostomy closure surgery if a temporary stoma was created, which may be performed using minimally invasive techniques for faster recovery and fewer complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a proctectomy procedure?
  2. What is the expected recovery time following a proctectomy?
  3. Will I need to make any lifestyle changes or modifications after the surgery?
  4. How will my bowel function be affected after a proctectomy?
  5. Are there any alternative treatment options to consider before proceeding with a proctectomy?
  6. What is the success rate of proctectomy procedures performed by minimally invasive techniques compared to conventional surgery?
  7. How experienced is the surgical team in performing proctectomy procedures using minimally invasive techniques?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. What is the long-term outlook for patients who undergo a proctectomy procedure?
  10. Are there any support groups or resources available for patients who have undergone a proctectomy?

Reference

Authors: Guerra F, Coletta D, Del Basso C, Giuliani G, Patriti A. Journal: World J Surg. 2019 Jul;43(7):1820-1828. doi: 10.1007/s00268-019-04962-8. PMID: 30824963