الفهرس 
DISEASES OF THE COLORECTAL SYSTEMOnly 14 pages are availabe for public view
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Abstract
Laparoscopic surgeries are considered safe and successful in the treatment of benign conditions. Benefits include decreased discomfort after surgery, quicker bowel recovery, and a shorter hospital stay in the short term. Long-term benefits include a decreased rate of incisional hernias and adhesion formation, which makes subsequent operations safer and faster. Additionally, when compared to open surgery, it is associated with more favorable cosmetic outcomes.
When treating individuals with inflammatory bowel illnesses, such as diverticular disease or inflammatory bowel disease that often affects neighboring tissues, the technical obstacles are greater in benign cases than in malignant cases.
Laparoscopic lavage is seen as an acceptable alternative to colonic resection in selected patients with acute diverticulitis with purulent peritonitis. There is no consensus on what surgical technique should be used when performing this procedure. Therefore, this case series shows promising results of laparoscopic lavage with direct suturing of colonic perforation in patients with diverticulitis with perforation and purulent peritonitis. Laparoscopic lavage in Hinchey III–perforated diverticulitis was feasible and in the short-term as safe as Hartmann’s procedure. We suggest that widespread implementation of the technique should await long-term results from the ongoing randomized trials.
Laparoscopic colon resection is feasible but not standardized regarding indication and surgical procedure. Indications are mainly benign diseases; diverticulitis, Crohn’s disease, ulcerative colitis and sessile dysplastic polyps or adenomas. Rare indications are benign tumors, angiodysplasia of the colon. Also Laparoscopic rectopexy and
Summary
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sutural closure of iatrogenic colon perforation have minimal invasive indication.
Surgeons starting laparoscopic colorectal surgery should select their cases. The biggest challenge faced by the general surgeon is the acquisition and mastering of the advanced laparoscopic skills that will allow him to deal with more complex procedures. The availability of specific equipment, such as laparoscopic sealing and stapling devices, and the surgeon’s familiarity with their use are also both essential to achieve excellent. We realize that selection bias must have played a significant role in this study as the laparoscopic approach was initially offered to carefully chosen patients with limited BMI index. This may in part explain our unexpectedly low conversion rate. This low incidence of anastomotic leak may be also partly explained by a good patients’ selection.
Before beginning laparoscopic colorectal surgery, surgeons should carefully choose their patients. It explains why the conversion rate was unexpectedly low. This reduced rate of extravasation may be due to patient selection.
There is a relatively short learning curve for laparoscopic sigmoid colectomy and hemicolectomy, respectively. Laparoscopic proctectomy is recommended as a next step for those with more expertise.
No cases in our study included LH or LHRP. However, for LH. The surgeon acquires good laparoscopic skills in the following key technical areas: moving the splenic flexure and descending colon, ligation of the supplying vessels, and control and containment of pathogens. A final overall difficulty rating was given to the LHRP. Adhesions in the left iliac fossa and the requirement to reposition the splenic flexure to provide stress-free anastomosis are two of the key
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reasons for the apparent difficulties in this technique. Direct visual trocars may be useful if access to the abdomen is problematic.
Other studies cannot use our research since it only evaluates our own practice, and our findings may not be generalizable to the general population.