الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 158 |  |  |
| | | from | 158 | | |
Abstract
Evidence-based practice and muti-centric trials comparing laparoscopic and open surgery for colon cancer had declared the advantages, non-inferiority, improved morbidity rates, the oncologic safety, and decrease mortality rates of the laparoscopic surgery.
The commonly used approaches for laparoscopic left hemi-colectomy are medial to lateral and lateral to medial approach. To date, there remain limited data supporting either medial or lateral approach for laparoscopic left colectomy.
The purpose was to evaluate the medial to lateral approach during laparoscopic left hemicolectomy in patients suffering from left colon cancer as regard to feasibility, safety, oncological resection, integrity of the meso-colon, lymph node harvest, operative time , conversion rate , major intraoperative accident (major bleeding, ureteric and gonadal vessels injury), recovery variables (bowel sounds, passage of gases, intake of liquids and solids), length of hospital stay, morbidity and mortality rates.
Forty patients with non-metastatic left colonic adenocarcinoma were confirmed by CT enterocolongraphy and colonoscopy with tissue biopsy. The lesions were located at different sites in the left side colon namely at splenic flexure (single case), left colon (19 case), rectosigmoid region (11 case) and sigmoid colon (9 cases). Left hemicolectomy was done in 20 patients, anterior resection in 11 patients and segmoidctomy in 9 patients. The patients were prospectively subjected to medial approach laparoscopic colectomy (the procedure starts by identification and ligation of the feeding artery (inferior mesenteric artery), followed by lateral dissection in the proper mesocolic plane, preservation of the retroperitoneal structures (ureter, gonadal vessels) and lastly division of the lateral peritoneal attachments). The study was conducted in the department of gastrointestinal surgery, faculty of medicine, Alexandria University, Egypt.
There were 22 males and 18 females, their ages ranged from 32 to 70 years with a mean ±SD of 55.61±9.78 years. Bleeding per rectum was the most common presentation in 52.5% of patients. 50% of patients underwent left hemicolectomy. The mean operative time was 227.3 ± 40.3 minutes and the mean blood loss was 212.2 ± 101 ml. Anastomotic leak was detected in 6 patients (15%) and surgical site infection (SSI) developed in 5 patients (12.5%), good to moderate meso-colon were obtained in 87.5% of the patient, the number of the extracted lymph-nodes exceeded 12 nodes in 75% of the patients, the free oncological resection margins were achieved in 95% of the cases , distal margin microscopic infiltration(R1) in single case 2.5%, CRM infiltrated in another case (2.5%). The need for diversion was reported in 8 case (20%). The hospital stay mean was 7.49±3.57 days. The six month recurrence and mortality rates reported single death, 3 cases of local recurrence and a single case of distant metastasis (brain deposit).