Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease

Chand, Manish, Siddiqui, Muhammed R.S., Gupta, Ashish, Rasheed, Shahnawaz, Tekkis, Paris, Parvaiz, Amjad, Mirnezami, Alex H. and Qureshi, Tahseen (2014) Systematic review of emergent laparoscopic colorectal surgery for benign and malignant disease. World Journal of Gastroenterology, 20 (45), 16956-16963. (doi:10.3748/wjg.v20.i45.16956). (PMID:25493008)

Abstract

Laparoscopic surgery has become well established in the management of both and malignant colorectal disease. The last decade has seen increasing numbers of surgeons trained to a high standard in minimally-invasive surgery. However there has not been the same enthusiasm for the use of laparoscopy in emergency colorectal surgery. There is a perception that emergent surgery is technically more difficult and may lead to worse outcomes. The present review aims to provide a comprehensive and critical appraisal of the available literature on the use of laparoscopic colorectal surgery (LCS) in the emergency setting. The literature is broadly divided by the underlying pathology; that is, inflammatory bowel disease, diverticulitis and malignant obstruction. There were no randomized trials and the majority of the studies were case-matched series or comparative studies. The overall trend was that LCS is associated with shorter hospital stay, par or fewer complications but an increased operating time.Emergency LCS can be safely undertaken for both benign and malignant disease providing there is appropriate patient selection, the surgeon is adequately experienced and there are sufficient resources to allow for a potentially more complex operation.

Core tip: Laparoscopic surgery is increasingly used in the emergency setting. This has been perceived to be a challenging surgical approach for such cases. However with appropriate expertise and training, laparoscopy can be used for colorectal emergencies with good short- and medium term outcomes.

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