Minimally Invasive Approach to Chagasic Megacolon: Laparoscopic Rectosigmoidectomy With Posterior End-to-Side Low Colorectal Anastomosis

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorARAUJO, Sergio E. A.
dc.contributor.authorBERTONCINI, Alexandre B.
dc.contributor.authorNAHAS, Sergio C.
dc.contributor.authorCECCONELLO, Ivan
dc.date.accessioned2014-09-30T14:40:58Z
dc.date.available2014-09-30T14:40:58Z
dc.date.issued2014
dc.description.abstractThe effectiveness of anterior resection for the surgical treatment of Chagasic megacolon and the advantages of laparoscopy for performing colorectal surgery are well known. However, current experience with laparoscopic surgery for Chagasic megacolon is restricted. Moreover, associated long-term results remain poorly analyzed. The aims of the present study were to ascertain the immediate results of laparoscopic anterior resection for the surgical treatment of Chagasic megacolon, to identify risk factors associated with adverse outcomes, and to settle late results. A retrospective review of a prospective database was conducted. Between November 2000 and September 2012, 44 patients with Chagasic megacolon underwent laparoscopic anterior resection with posterior end-to-side low colorectal anastomosis. Fifteen (34.1%) patients were male. Mean age was 51.6 years (31 to 77 y). The mean body mass index (BMI) was 22.9 kg/m(2) (16.9 to 36.7 kg/m(2)). Thirty-four previous abdominal operations had been performed. Mean operative time was 265 minutes (105 to 500 min). Four surgeons operated on all cases. Surgeon's experience with the operation was not associated with surgical time (P=0.36: linear regression). Mean operative time between patients with and without previous abdominal surgery was similar (237.7 vs. 247.5 min: P=0.78). There was no association between BMI and the duration of the operation (P=0.22). Intraoperative complications occurred in 2 (4.5%) cases. Conversion was necessary in 3 (6.8%) cases. There was no association between conversion and previous abdominal surgery (P=0.56) or between conversion and surgeon's experience (P=0.43). However, a significant association (P=0.01) between BMI and conversion was observed. Postoperative complications occurred in 10 (22.7%) cases. Anastomotic-related complications occurred in 4 cases. Two of them required diversion ileostomy. Restoration of transanal evacuation was achieved in all cases. Mean duration of postoperative hospital stay was 9.8 days (4 to 45 d). Of 19 patients with known clinical late follow-up, only 1 (5.3%) reported use of enemas and 5 (26.3%) reported use of laxatives. Thirteen (68.4%) patients reported daily bowel movements. There was no association between postoperative complications and use of laxatives (P=0.57). It was concluded that laparoscopic anterior resection for Chagasic megacolon is safe. Obesity was a risk factor for conversion. Restoration of transanal evacuation after surgical treatment of infectious complications was achieved. Minimally invasive surgery for Chagasic megacolon is associated with satisfactory late intestinal function with no significant constipation relapse.
dc.description.indexMEDLINE
dc.identifier.citationSURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, v.24, n.3, p.207-212, 2014
dc.identifier.doi10.1097/SLE.0000000000000002
dc.identifier.eissn1534-4908
dc.identifier.issn1530-4515
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/7505
dc.language.isoeng
dc.publisherLIPPINCOTT WILLIAMS & WILKINS
dc.relation.ispartofSurgical Laparoscopy Endoscopy & Percutaneous Techniques
dc.rightsrestrictedAccess
dc.rights.holderCopyright LIPPINCOTT WILLIAMS & WILKINS
dc.subjectmegacolon
dc.subjectlaparoscopy
dc.subjectrectum
dc.subjectconstipation
dc.subjectintestinal volvulus
dc.subjectsurgical staplers
dc.subjectintraoperative complications
dc.subjectpostoperative complications
dc.subjectintestinal fistula
dc.subjectsurgical stomas
dc.subject.otherprevious abdominal-surgery
dc.subject.otherlearning-curve
dc.subject.otheropen colectomy
dc.subject.otherassisted colectomy
dc.subject.othersurgical-treatment
dc.subject.othernonobese patients
dc.subject.otherrandomized-trial
dc.subject.otheroutcomes
dc.subject.otherobesity
dc.subject.otherimpact
dc.titleMinimally Invasive Approach to Chagasic Megacolon: Laparoscopic Rectosigmoidectomy With Posterior End-to-Side Low Colorectal Anastomosis
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus1
hcfmusp.contributor.author-fmusphcSERGIO EDUARDO ALONSO ARAUJO
hcfmusp.contributor.author-fmusphcALEXANDRE BRUNO BERTONCINI
hcfmusp.contributor.author-fmusphcSERGIO CARLOS NAHAS
hcfmusp.contributor.author-fmusphcIVAN CECCONELLO
hcfmusp.description.beginpage207
hcfmusp.description.endpage212
hcfmusp.description.issue3
hcfmusp.description.volume24
hcfmusp.origemWOS
hcfmusp.origem.pubmed24710265
hcfmusp.origem.scopus2-s2.0-84902271055
hcfmusp.origem.wosWOS:000337501300013
hcfmusp.publisher.cityPHILADELPHIA
hcfmusp.publisher.countryUSA
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