75 laparoscopic (L) and laparosco-pically assisted (LA) colorectal procedures have been performed including 32 LA total abdominal colectomies (Group 1), 34 segmental colectomies (Group 2), and 10 stomas and other procedures (Group 3). Indications included colitis in 27 patients, other benign diseases in 36, and carcinoma in 12 patients. Intraoperative and postoperative complications were noted in 14% and in 21% of patients, respectively. However, the complications rate was 50% in the first 25 cases and 13% in the last 25 cases. Length of ileus was 3.8 (2-7) days in Group 1, 3.5 (2-7) days in Group 2, and 3. L and LA colectomy are feasible, although at the present time, the complications rate is more impressive than is the length of hospitalization.
Lynch syndrome I is characterized by an autosomal dominant predisposition to colorectal cancer (CRC) with predilection to the proximal colon and an excess of metachronous CRC. The Lynch syndrome II variant shows these same features but, in addition, shows significant excess of carcinomas of the endometrium, ovary, ureter, renal pelvis, small bowel, and stomach. There are no premonitory physical signs of cancer risk. The gene has been recently mapped to chromosome 2p15-16 (Science 260:810-812, 1993) and, once cloned, will significantly abet the detection of gene carriers through a simple blood test. The disorder is common and may account for between 6-10% of the total CRC burden. Surveillance must be responsive to its natural history. In both variants, we recommend colonoscopy to be initiated at age 25 and repeated every other year, and in Lynch syndrome II, surveillance for extracolonic cancer. Because of the excess of metachronous cancer, subtotal colectomy is necessary for initial CRC.
Controlled randomized studies were conducted to investigate whether and if so to what extent the pelvic pouch design (J-, S-, W- or K-pouch) and/or the approach for proctectomy and construction of the pouch-anal anastomosis (endoanal mucosectomy and handsewn = HS or transabdominal proctectomy with stapling to the top of anal canal = STP) might influence the functional outcome. Manovolumetry at regular intervals postoperatively and a detailed functional protocol were used to evaluate results. S-, W- and K-pouches proved at all intervals to have a significantly better volume capacity than the J-pouch but the functional results were largely the same. Resting anal pressure (RAP) decreased to a similar extent in the HS- and the STP-patients. It remained still reduced by about 25% at one year, -similar in both groups of patients. HS-patients tended to suffer from night soiling, more frequently. Otherwise functional results differed but little. Pouch design and proctectomy techniques appear to account for only a minor fraction of the total variance of functional outcome. General and gradual adaptation mechanisms and other patients factors may be important functional determinants.