Our Summary

This research paper discusses a study aiming to understand if it’s feasible and safe to perform emergency colorectal surgery laparoscopically (a minimally invasive surgical technique) instead of traditional open surgery.

The study, called the LaCeS trial, took place across five medical centers and included 64 patients, who were split evenly into two groups: one to have laparoscopic surgery and the other open surgery.

The researchers found that about 39% of the time, the doctors had to switch from the planned laparoscopic procedure to open surgery. They also found that just over a quarter of patients who had the laparoscopic surgery experienced complications within 30 days, compared to about 42% of those who had open surgery.

The study concluded that emergency laparoscopic colorectal surgery could be a safe alternative to open surgery. However, as this was a feasibility study, more extensive research would be needed to confirm these findings.

FAQs

  1. What is the purpose of the LaCeS trial in the study?
  2. What were the findings of the study in terms of complications between laparoscopic and open surgeries?
  3. Can emergency laparoscopic colorectal surgery be considered a safe alternative to open surgery based on the study’s findings?

Doctor’s Tip

One helpful tip a doctor might tell a patient about colorectal surgery is to discuss the possibility of laparoscopic surgery as a potential option, as it may offer a quicker recovery time and potentially fewer complications compared to traditional open surgery. It’s important to have an open and honest conversation with your doctor about the best approach for your individual situation.

Suitable For

Patients who may be recommended for colorectal surgery include those with conditions such as:

  1. Colorectal cancer: Surgery is often recommended as part of the treatment for colorectal cancer, either to remove the tumor or to relieve symptoms.

  2. Inflammatory bowel disease: Patients with conditions such as Crohn’s disease or ulcerative colitis may require surgery if medications are not effective in managing their symptoms.

  3. Diverticulitis: Severe cases of diverticulitis, an inflammation of small pouches in the colon, may require surgery to remove the affected part of the colon.

  4. Colorectal polyps: Large or precancerous polyps may need to be removed surgically to prevent the development of colorectal cancer.

  5. Rectal prolapse: Surgery may be recommended to repair a rectal prolapse, where the rectum protrudes from the anus.

  6. Rectal or anal fistulas: Surgery may be required to treat fistulas, abnormal connections between the rectum or anus and other organs.

  7. Bowel obstruction: Surgery may be necessary to remove a blockage in the colon or rectum.

It is important for patients to discuss their specific condition and treatment options with their healthcare provider to determine if colorectal surgery is the best course of action for them.

Timeline

Before colorectal surgery, a patient typically undergoes a series of tests and evaluations to determine the best course of treatment. This may include blood tests, imaging scans, and consultations with various medical professionals. The patient may also need to make lifestyle changes, such as altering their diet or stopping certain medications.

On the day of surgery, the patient will be admitted to the hospital and prepared for the procedure. This may involve fasting, receiving anesthesia, and being prepped for surgery in the operating room. The surgical team will perform the procedure, whether it be laparoscopic or open surgery, and monitor the patient’s vital signs throughout.

After the surgery, the patient will be closely monitored in the recovery room before being transferred to a hospital room or intensive care unit. They will receive pain medication, fluids, and possibly antibiotics to prevent infection. The medical team will encourage the patient to start moving around as soon as possible to aid in the recovery process.

In the days following surgery, the patient will gradually resume eating solid foods and may need to perform breathing exercises or physical therapy to prevent complications like pneumonia or blood clots. They will also have follow-up appointments with their surgeon to monitor their progress and address any concerns.

Overall, the recovery process from colorectal surgery can vary depending on the individual patient and the specific procedure performed. It is important for patients to follow their doctor’s instructions closely and communicate any changes in symptoms or concerns during the recovery period.

What to Ask Your Doctor

  1. What are the potential benefits of laparoscopic colorectal surgery compared to traditional open surgery?
  2. What are the risks and potential complications associated with laparoscopic colorectal surgery?
  3. How experienced is the surgical team in performing laparoscopic colorectal surgery?
  4. What factors would make me a good candidate for laparoscopic colorectal surgery?
  5. What is the expected recovery time and post-operative care for laparoscopic colorectal surgery?
  6. Will I need any additional tests or preparation before undergoing laparoscopic colorectal surgery?
  7. What is the likelihood of needing to switch from laparoscopic surgery to open surgery during the procedure?
  8. How will my pain be managed after laparoscopic colorectal surgery?
  9. What long-term effects or considerations should I be aware of after undergoing laparoscopic colorectal surgery?
  10. Are there any alternative treatment options to consider besides surgery?

Reference

Authors: Harji DP, Marshall H, Gordon K, Twiddy M, Pullan A, Meads D, Croft J, Burke D, Griffiths B, Verjee A, Sagar P, Stocken D, Brown J; LaCeS Collaborators. Journal: Br J Surg. 2020 Nov;107(12):1595-1604. doi: 10.1002/bjs.11703. Epub 2020 Jun 23. PMID: 32573782