الفهرس 
Anatomy Of The Colon And The RectumOnly 14 pages are availabe for public view
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Abstract
Minimally invasive surgery is the most important revolution in surgical technique since the early 1900s. Its development was facilitated by the introduction of miniaturised video cameras with good image reproduction. Laparoscopic cholecystectomy was the first procedure to be widely accepted.
The use of minimally invasive approaches in the surgical management of colorectal diseases continues to gain popularity. Laparoscopy has clear advantages and can be performed in a majority of patients at surgical centers with experienced surgeons. As technology marches forward, newer techniques will continue to advance the quality of patient care.
The indications for laparoscopic colectomy are essentially the same as the indications for an open procedure, and can be sub grouped into colectomy for benign disease and for malignant disease.
Benign disease: This includes inflammatory bowel disease (ulcerative colitis and Crohn’s disease), diverticular disease, rectal prolapse, and colonic dysmotility.
Malignant disease: This includes polyps not amenable to colonoscopic resection, colorectal cancers, and hereditary colon cancer syndromes such as familial adenomatous polyposis, hereditary nonpolyposis colorectal cancer (HNPCC).
Most studies have shown a decrease in both the dose and duration of parenteral analgesia required after laparoscopic surgery. Also the majority of trials show that on average, both time to flatus and bowel movement are a day earlier in laparoscopic surgery than open surgery. This also translates into earlier resumption of oral intake. The overall hospital stay is decreased by 1 to 2 days for laparoscopic surgery for the reasons mentioned previously.
Most evidence suggests that laparoscopic colectomy can be performed safely for several pathologic conditions. The resulting advantages of smaller wounds, shorter ileus, earlier resumption of dietary intake, and reductions in length of hospital stay are associated with this approach.
Laparoscopic procedures have to be safe and successful for the management of colorectal diseases. Laparoscopic surgery for Crohn’s disease should be considered as the preferred operative approach for primary resections.
The magnitude of benefits achieved with laparoscopic colectomey for diverticular disease in the hand of experienced laparoscopic colorectal surgeons may soon be sufficient to make laparoscopic colectomey as a routine procedure. However, complicated diverticular disease does present additional challenges, and should not be undertaken without considerable experience in laparoscopic assisted colectomy.
Laparoscopic surgery for total colectomy or proctocolectomy for ulcerative colitis seems to be safe with good long-term results. Whether or not there are advantages over the open method remains to be proven in larger prospective comparative studies.
It seems clear that with advancing learning curves and technology, the ease of laparoscopic surgery has improved, leading to a decrease in operative times. Laparoscopic surgery also appears to be oncologically sound with regard to specimen resection, clearance, and lymph node harvest, and certainly comparable to open colectomy.
There is now a wealth of evidence confirming the safety and feasibility of laparoscopic colorectal cancer surgery. In the vast majority of reports, postoperative mortality rates following laparoscopic colorectal cancer excision were low. Mortality rates were similar, and there was no increased overall morbidity when compared with open surgery in most comparative studies.
Local and distant recurrence rates are similar to those for open procedures, with no difference in the patterns of recurrence. Advanced disease can be a challenge laparoscopically; however, there are no differences in the patterns or frequency of recurrence when compared with open procedures.