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Laparoscopic Colectomy: Medial Versus Lateral Approach

Rotholtz, Nicolas A. MD; Bun, Maximiliano E. MD; Tessio, Margarita MD; Lencinas, Sandra M. MD; Laporte, Mariano MD; Aued, Maria L. MD; Peczan, Carlos E. MD; Mezzadri, Norberto A. MD, FACS

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: February 2009 - Volume 19 - Issue 1 - p 43-47
doi: 10.1097/SLE.0b013e31818e91f3
Original Articles
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Background Laparoscopic colectomy can be performed using 2 approaches: lateral or medial. However, it is unknown if one of these techniques provides better results. Thus, the object of the present study is to assess whether one of the approaches has any potential benefits over the other.

Methods A comparative, retrospective study was performed that included all patients scheduled for left and right laparoscopic colon resection for both neoplastic and benign diseases between June 2000 and June 2006. The following factors were assessed: operation time, recovery variables (bowel sounds, passage of gases, intake of liquids and solids), length of hospital stay, and morbidity and mortality rates. The population was divided into 4 groups: right colectomy using a lateral approach (RL); right colectomy using a medial approach (RM); left colectomy using a lateral approach (LL); and left colectomy using a medial approach (LM).

Results A total of 202 patients were evaluated: RL: 16 (8%); RM: 37 (18.3%); LL: 110 (54.4%); LM: 39(19.3%). No differences in recovery parameters were observed between the right colectomies. However, the presence of bowel sounds and solid intake was significantly earlier in the patients subjected to left colectomies using a medial approach. A tendency toward a higher conversion rate was observed in left colectomies with lateral approach (LL: 18 vs. LM: 1, P=0.052). The operation time was significantly shorter when a medial approach was used for both right and left colectomies (RL: 185.6 min vs. RM: 148.6 min, P=0.009; LL: 205.5 min vs. LM: 139.9 min, P<0.0001). No differences in the morbidity and mortality rates were found between lateral and medial approach in both types of colectomy.

Conclusions The use of a medial approach in a laparoscopic colectomy provides short-term benefits compared with a lateral approach.

Colorectal Surgery Section, General Surgery Department, Hospital Alemán de Buenos Aires, Argentina

Reprints: Maximiliano E. Bun, MD, Colorectal Surgery Section, General Surgery Department, Hospital Alemán, 1640 Pueyrredón Ave, Buenos Aires C1118, Argentina (e-mail: maxibun@hotmail.com).

Received for publication November 24, 2007; accepted July 18, 2008

© 2009 Lippincott Williams & Wilkins, Inc.