Prospective study of ambulation after open and laparoscopic colorectal resection.

摘要

PURPOSE: Open and laparoscopic surgical approaches each have specific advantages. This study compares ambulation, hospital length of stay (LOS), and incision length after open and laparoscopic colorectal resection. METHODS: All consecutive patients undergoing colorectal resection over a 2 year period ending August 2002 were followed prospectively. Ambulation, LOS, and incision length were recorded. Hybrid low anterior resection (LAR) patients had laparoscopic splenic flexure takedown, vessel ligation, and proximal rectal mobilization followed by planned inferior laparotomy to complete the case. Groups were compared using Student's t test. RESULTS: Equivalent open and laparoscopic groups were comparable in terms of gender, age, body mass index, ASA class, indication for operation, and resection performed. Seventy open colectomy patients were compared with 99 laparoscopic-assisted colectomy patients. On average, patients in the open and laparoscopic groups ambulated 67 and 390 feet, respectively, on postoperative day 1 (P < .001), 290 and 752 feet on day 2 (P < .001), and 495 and 965 feet on day 3 (P < .001). The average LOS in the open group was 9.3 days compared with 5.9 days in the laparoscopic group (P < .001). The average incision length in the open group was 19.7 cm compared with 5.3 cm in the laparoscopic group (P < .001). Seventeen open LAR patients were compared with 30 hybrid LAR patients. On average, patients in the open and hybrid groups ambulated 22 and 150 feet, respectively, on postoperative day 1 (P = .003), 105 and 433 feet on day 2 (P = .003), and 369 and 488 feet on day 3 (P = .43). The average LOS in the open group was 10 days compared with 8.5 days in the hybrid group (P = .46). The average incision length in the open group was 19.8 cm compared with 10.8 cm in the hybrid group (P < .001). When all 216 patients were considered, the 91 patients with incisions shorter than 8 cm (average 4.6 cm) ambulated 396, 752, and 956 feet on consecutive days whereas the 125 patients with incisions 8 cm or longer (average 16.9 cm, P < .001) ambulated 101, 334, and 521 feet on consecutive days (all P values <.001). Average LOS in the <8-cm group was 6 days compared with 8.9 days in the > or =8-cm group (P < .001). CONCLUSIONS: Patients undergoing minimal-access colorectal surgery ambulated significantly further than equivalent open patients in the early postoperative period and had a shorter LOS.