Lessons from laparoscopic surgery-a fresh look at post-operative management after major colorectal procedures

Abstract

Laparoscopy holds promise of exciting advances in colorectal surgery, yet the data we require to draw appropriate evidence-based conclusions on its apparent advantages are sadly lacking. In the meantime, our focus on improved recovery after major colorectal resections has changed the way we manage patients after open surgery. A literature review was undertaken to collect published data on laparoscopic colorectal surgery. In addition, data on newer developments in open colorectal surgery were collected. Although there are many published data in laparoscopic colorectal surgery, very few are randomized and controlled. It is clear that, at least in the short to medium term, oncological outcomes are comparable to open surgery. There are data suggesting advantages, including less immune suppression, faster recovery with earlier feeding, less ileus, shorter length of stay and earlier return to normal activity. Unfortunately, due to study design the data are largely not comparable with open surgery data, and open surgery itself has changed to some extent recently. We must encourage recruitment of patients into current ongoing randomized controlled trials of laparoscopic and open surgery and await the results.