Our Summary

This research paper analyzes a type of surgery called “HAL colectomy”, which is a method used to remove part of the colon. This technique is seen as beneficial as it’s less invasive and thought to improve the surgeon’s feel during the operation and reduce the time of surgery. However, most of the existing studies on this are small and limited to single institutions.

The researchers used data from a national surgical improvement program to compare outcomes of patients who underwent either a HAL colectomy or another type of surgery called SL colectomy. They matched patients with similar characteristics 1:1 for a fair comparison.

The study involved 13,949 patients, with nearly 44% of them undergoing the HAL colectomy. The results showed that patients who had the HAL colectomy had higher rates of postoperative ileus (a disruption of the normal movement of the gut after surgery), wound complications, and readmissions to the hospital within 30 days of surgery. There was no significant difference in the time it took to perform the two types of surgeries.

The findings suggest that the HAL colectomy does carry some potential risks, including wound complications, issues with gut movement after surgery, and higher rates of hospital readmissions. Contrary to previous beliefs, the technique did not reduce the time of the surgery. This study implies that more consideration may be needed when choosing the type of surgery for colon removal.

FAQs

  1. What is HAL colectomy and how does it differ from SL colectomy?
  2. What are the potential risks associated with HAL colectomy as per the study?
  3. Does the HAL colectomy technique decrease the operative time compared to SL colectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about laparoscopic colectomy is to be aware that hand-assisted laparoscopic colectomy (HAL) may be associated with higher rates of postoperative ileus, wound complications, and readmissions compared to standard laparoscopic colectomy (SL). It is important to discuss these potential risks with your surgeon and weigh them against the benefits of the HAL technique before making a decision on your surgical approach.

Suitable For

Patients who are typically recommended for laparoscopic colectomy include those with colorectal conditions such as colon cancer, diverticulitis, inflammatory bowel disease, and benign colorectal tumors. Patients who are young, healthy, and have a lower body mass index may also be good candidates for laparoscopic colectomy. Additionally, patients who have not had previous abdominal surgeries or have minimal scarring in the abdomen may benefit from this minimally invasive approach.

Timeline

Before laparoscopic colectomy:

  • Patient consults with a colorectal surgeon to discuss treatment options for their condition
  • Patient undergoes preoperative evaluations and tests to assess their overall health and suitability for surgery
  • Patient receives instructions on preoperative preparation, such as diet modifications and medication adjustments
  • Patient undergoes laparoscopic colectomy procedure under general anesthesia
  • Patient is monitored in the recovery room before being transferred to a hospital room for postoperative care
  • Patient may experience pain, discomfort, and possible complications such as postoperative ileus or wound infection

After laparoscopic colectomy:

  • Patient is monitored closely for complications and recovery progress in the hospital
  • Patient may be discharged from the hospital within a few days if they are stable and recovering well
  • Patient is instructed on postoperative care, including wound care, pain management, and diet restrictions
  • Patient follows up with their surgeon for postoperative visits to monitor healing and address any concerns
  • Patient gradually resumes normal activities and may undergo physical therapy or rehabilitation to improve strength and mobility
  • Patient may experience improvements in their symptoms and quality of life following successful laparoscopic colectomy

What to Ask Your Doctor

  1. What are the potential benefits of undergoing a hand-assisted laparoscopic colectomy compared to a standard laparoscopic colectomy?
  2. What are the potential risks or complications associated with hand-assisted laparoscopic colectomy?
  3. How does the recovery process differ between hand-assisted laparoscopic colectomy and standard laparoscopic colectomy?
  4. Are there any specific qualifications or experience required by the surgical team to perform a hand-assisted laparoscopic colectomy?
  5. What are the success rates or outcomes typically seen with hand-assisted laparoscopic colectomy compared to other surgical techniques?
  6. Are there any specific factors or conditions that would make a patient a better candidate for hand-assisted laparoscopic colectomy versus other surgical options?
  7. How long can a patient expect to be in the hospital following a hand-assisted laparoscopic colectomy procedure?
  8. Are there any long-term implications or considerations to be aware of after undergoing a hand-assisted laparoscopic colectomy?
  9. What is the follow-up care or monitoring required after undergoing a hand-assisted laparoscopic colectomy procedure?
  10. Are there any lifestyle changes or dietary restrictions that should be followed after undergoing a hand-assisted laparoscopic colectomy?

Reference

Authors: Gilmore BF, Sun Z, Adam M, Kim J, Ezekian B, Ong C, Migaly J, Mantyh CR. Journal: J Gastrointest Surg. 2016 Nov;20(11):1854-1860. doi: 10.1007/s11605-016-3206-z. Epub 2016 Jul 25. PMID: 27456018