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首页> 外文期刊>Surgical Endoscopy >Combination of hand-assisted and laparoscopic proctocolectomy (HALP): Technical aspects, learning curve and early postoperative results.
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Combination of hand-assisted and laparoscopic proctocolectomy (HALP): Technical aspects, learning curve and early postoperative results.

机译：手辅助和腹腔镜直肠癌联合切除术（HALP）的结合：技术方面，学习曲线和早期术后结果。

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BACKGROUND: Various techniques for laparoscopic proctocolectomy have been reported worldwide. We evaluated the technical aspects and early postoperative results of hand-assisted laparoscopic proctocolectomy (HALP) with construction of an ileal pouch-anal anastomosis through a Pfannenstiel incision. PATIENTS AND METHODS: Between June 2004 and May 2006, 20 patients (median age 28 years) underwent combined HALP at our institution. Preoperative diagnosis included ulcerative colitis (n = 16), indeterminate colitis (n = 1), familial adenomatous polyposis (n = 2), and carcinoma of the rectum associated with ulcerative colitis (n = 1). All patients were under immunosuppressive therapy. Laparoscopic mobilisation of rectum, sigmoid and descending colon was performed first. Subsequently, hand-assisted laparoscopic mobilization of the transverse and ascending colon as well as creation of an ileal J-pouch were performed through a Pfannenstiel incision. Ileal pouch-anal anastomosis was completed by transrectal stapling device and protected by a loop ileostomy. RESULTS: The ileal pouch-anal anastomosis could be achieved in 19 cases (95%). There was one conversion (5%) to open surgery with construction of an end-ileostomy. No intraoperative blood transfusions were necessary. The median operating time was 210 minutes (range 180 min to 330 min). It was longer for the first five procedures but then remained constant. Two patients (10%) developed anastomotic leakage, which could be treated conservatively. Mean length of hospital stay was 11 days (range 7-32 days). CONCLUSIONS: Combined HALP with construction of an ileal J-pouch-anal anastomosis can be performed safely and effectively. The Pfannenstiel incision proved to be advantageous for hand-assisted mobilisation of the transverse colon. Additionally, it was useful for the specimen removal and the J-pouch construction. Our new technique not only proved to be safe, but also resulted in a shortened total operation-time after a learning curve of about five procedures.
机译：背景：全球范围内已报道了各种用于腹腔镜直肠结肠切除术的技术。我们评估了手辅助腹腔镜直肠切除术（HALP）的技术方面和早期术后结果，并通过Pfannenstiel切口构建了回肠袋-肛门吻合术。患者与方法：2004年6月至2006年5月，我们机构对20例患者（中位年龄28岁）进行了联合HALP治疗。术前诊断包括溃疡性结肠炎（n = 16），不确定性结肠炎（n = 1），家族性腺瘤性息肉病（n = 2）和与溃疡性结肠炎有关的直肠癌（n = 1）。所有患者均接受免疫抑制治疗。首先进行腹腔镜直肠，乙状结肠和降结肠的动员。随后，通过Pfannenstiel切口进行腹腔镜动员的横结肠和升结肠的动员以及回肠J袋的创建。回肠吻合术完成回肠袋肛门吻合术，并通过回肠回肠造口术进行保护。结果：回肠囊袋肛门吻合术可实现19例（95％）。有一种转换（5％）转换为开放式手术，并采用回肠造口术。无需术中输血。中值操作时间为210分钟（范围为180分钟至330分钟）。前五个过程的时间较长，但随后保持不变。两名患者（10％）发生了吻合口漏，可以保守治疗。平均住院时间为11天（范围7-32天）。结论：结合HALP和回肠J-袋-肛门吻合术可以安全有效地进行。事实证明，Pfannenstiel切口有利于手助横结肠的动员。此外，它对于标本去除和J型袋结构很有用。我们的新技术不仅被证明是安全的，而且在经过大约五个过程的学习曲线后，还缩短了总操作时间。

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