What is included in postoperative care following laparoscopic left hemicolectomy?

Updated: Apr 13, 2020
  • Author: David B Stewart, Sr, MD, FACS, FASCRS; Chief Editor: Vikram Kate, MBBS, MS, PhD, FRCS, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Answer

With regard to the typical course of patients undergoing a laparoscopic left colectomy, their bladder catheter is removed within 24 hours after the procedure, and a solid food diet is started immediately after surgery. The patient is provided with low-dose patient-controlled analgesia, and every effort is made to use nonsteroidal anti-inflammatory drugs (NSAIDs) and other nonopioid medications to control surgical-site discomfort.

The patient may be safely discharged home once the passage of flatus resumes, which is usually on postoperative day 2 or 3. Given that most patients undergo mechanical bowel preparation, awaiting a bowel movement would seem to introduce an unnecessary delay in hospital discharge.

A study by Pardo Aranda et al suggested that fast-track recovery protocols could be applied to single-port laparoscopic surgical procedures on the colon as safely and effectively as they could to multiport laparoscopic surgical procedures. [27]

A prospective study of patients undergoing elective colorectal resections found that those treated with a standardized enhanced recovery program (ERP; n = 100), as compared with those treated before the introduction of the ERP (n = 100), had significantly shorter hospital stays, imposed lower nursing worloads, and showed no increase in postoperative complications, 30-day readmission, or mortality. [28] In addition, total mean direct costs per patient were significantly higher for patients in whom the ERP was not implemented.

A study was conducted on repeat laparoscopic colorectal resection (LCRR)- it’s safety and feasibility. (Zarzavadjian le Bian A, Genser L, Denet C, et al. Safety and feasibility of repeat laparoscopic colorectal resection: a matched case-control study. Surg Endosc. 2020 May;34(5):2120-2126.) About 23 patients who had colorectal cancer (CRC) or benign conditions and who underwent right sided resection or left-sided resection or proctectomy were included in the study. Indications for repeat LCRR were CRC, dysplasia, anastomotic stricture, inflammatory bowel disease.  Thirteen (57%) patients required conversion to laparotomy including 12 for intense adhesions. It was found that the repeat LCRR group had higher conversion rate, operative time and intraoperative blood loss compared to a primary LCRR. They concluded that there was no compromise in the oncological outcomes in a repeat LCRR and it is a safe and feasible procedure for CRC.


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