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Aim: To compare the early and late complications after left colectomy (LC) by left transverse laparotomy (LTL), midline laparotomy (ML) and laparoscopy (La). Methods: From 1998 to 2003, 328 patients underwent an LC by LTL, ML or La. After matching patients for age, ASA score and indication, 159 patients were divided into three groups of 53 patients each according to the surgical approach performed. The median follow-up was 8 years. Early and late complications were compared by univariate and multivariate analysis. Results: Early morbidity rates after LTL, ML and La were 52 %, 45 % and 21 %, respectively ( p = 0.002). Extra digestive complication rates after LTL, ML and La were 36 %, 34 % and 13.2 %, respectively ( p = 0.02). Respiratory complication rates were 15 %, 21 % and 2 % ( p = 0.01). The rate of wound infection was higher after LTL (15 % vs. 6 % and 6 %, p = 0.06). Length of stay was significantly shorter after La (median: LTL, 10 days; ML, 9 days; La, 6 days; p < 0.0001). At a median follow-up of 8 years, the obstruction rate was 6.3 %, regardless of the surgical approach. The rates of incisional hernia after LTL, ML and La were 8 %, 23 % and 3 % ( p = 0.004), respectively, with odds ratio (OR) = 4.47 (1.2 to 16). Conclusion: Our study shows that although La has a significant lower rate of complications, LTL, with fewer respiratory complications and hernia than ML, should be considered as the reference incision in case of conversion or contra-indication for laparoscopy. [ABSTRACT FROM AUTHOR]

This article presents a commentary on the article, published in this issue, by researchers Rob A.G. Nordkam and Simone J.M. Bluyssen illustrating a study of surgical infections due to perforated surgical gloves. The study has demonstrated randomized clinical trial comparing blunt needles in abdominal surgery. It is argued that breaches in gloving material may expose surgeons and operating room staff to risk of contact with patients' blood and body fluids and related infections. The author claims that the present randomized study from The Netherlands, which compares closure of laparotomy with 2 different needles, sharp or blunt, is an additional demonstration that the use of blunt-tipped needles, while not eliminating the risk, significantly reduces the incidence of surgical glove puncture and perforation. He advises that the use of cutting needles for abdominal closure should be abandoned.