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Background: The development of modern videoendoscopy enables surgeons to perform laparoscopic resection of colonic cancer. Aim: This manuscript evaluated the literature concerning clinically relevant differences in the short and long-term course after laparoscopic or conventional resection of colonic cancer. Methods: An investigation of meta-analyses from randomized controlled clinical trials comparing laparoscopic and conventional surgery for colonic cancer was carried out. Results: The incidence of intraoperative complications was higher during laparoscopic surgery, the duration of surgery was increased and blood loss was less when compared to open surgery. Overall morbidity and the incidence of surgical complications were decreased after laparoscopic surgery. General morbidity and mortality were not different after laparoscopic or open resection of colonic cancer. Duration of hospital stay was shorter but was also associated with the type of perioperative care (i.e. traditional or enhanced recovery). Following minimally invasive or conventional resection, the incidence of tumor recurrence (local and distant) and the duration of survival (overall and disease-free) showed no differences. Wound implantations were rare after both operative techniques but with a tendency to occur more often after laparoscopic than open resection. Conclusion: Laparoscopic resection of colonic cancer has clinically relevant short-term benefits for the patients and long-term results are not different from open colectomy. However, most of the patients included in randomized controlled trials underwent right or left colectomy and sigmoid or rectosigmoid resections. Data with a high level of evidence concerning carcinomas of the flexures or the transverse colon do not exist. Suitable patients with colonic cancer should undergo laparoscopic resection by experienced surgeons. [ABSTRACT FROM AUTHOR]

Summary: Background: Although visual analogue scales in conventional mechanical form (mVAS) and electronical VAS (eVAS) on PDA devices are used to evaluate pain in surgical patients, it is not clear whether results of both instruments are comparable. Therefore, the level of agreement between both VAS instruments was evaluated in patients undergoing general surgery. Methods: After general surgery, 53 patients assessed their pain at rest and while coughing by mVAS and eVAS at the same time. mVAS and eVAS data were correlated and the level of agreement between both was calculated according to the method of Bland and Altman. Thirty-three female and 20 male patients in the median age of 51 (18–78) years participated in this study and a total of 185 data sets (112 at rest, 73 while coughing) were evaluated. Results: When data at rest and while coughing were analysed together, correlation between mVAS and eVAS was very good (r =0.902, p <0.001). While the mean VAS score was 4.5cm, mVAS and eVAS differed from each other by only 0.22cm (4.4% of mean VAS score). However, standard deviation of the difference (“repeatability coefficient”) was 1cm (22% of the mean VAS) and the lower and upper level of agreement ranged from −0.21 to 0.17cm (−47 to 38%). Separate analysis for mVAS and eVAS during rest and while coughing revealed similar results. Conclusion: After elective general surgery, correlation between mVAS and eVAS was high. While measurements with both instruments differ in average only by less than 5%, those differences may vary considerably in individual measurements. The type of VAS (mVAS or eVAS) should not be changed within one trial. Results obtained with different forms of VAS should be compared only with caution. [Copyright &y& Elsevier]

Background: A reduced peritoneal fibrinolytic capacity after surgery is currently accepted to be the main cause for postoperative adhesions. The aim of this prospective randomized trial was to determine the fibrinolytic activity in peritoneal fluid after laparoscopic as compared to conventional colorectal resection. Methods: A randomized controlled trial in parallel with the multicenter trial Lapkon II was conducted. Peritoneal fluid was sampled via drain at 2, 8, and 24 h after elective laparoscopic (n=14; LAP) and conventional (n=16; CON) colorectal resections. Activities and concentrations of tissue plasminogen activator (t-PA), plasminogen activator inhibitor type-1 (PAI-1) and t-PA/PAI complex were determined in all specimen by ELISA kits. Results: There was no difference in age, sex or body mass index between both groups. Postoperatively, t-PA activity decreased in both groups and was lower 2 h after closing the abdomen in the laparoscopic group (p<0.05). PAI-1 activity and concentration increased in both groups. Difference between the groups was measured for PAI-1 concentration after 24 h (p<0.05). There were no differences between the groups regarding t-PA concentrations, PAI-1 activity and t-PA/PAI complex. Conclusions: After closing the abdominal cavity, postoperative changes in fibrinolytic capacity of peritoneal fluid can be determined in samples collected by a drain. However, there were no major differences in the postoperative course of fibrinolytic capacity in peritoneal fluid after laparoscopic and conventional colorectal resections. [ABSTRACT FROM AUTHOR]

Background and aims: Reduced fibrinolytic activity of the peritoneum seems to be the main cause of postoperative adhesions. This prospective randomized trial compared the peritoneal fibrinolytic activity between laparoscopic and conventional colorectal resection. Methods: Parietal peritoneal biopsy specimens were taken in standardized elective laparoscopic (n=14) and conventional (n=16) colorectal resections at the beginning and at the end of surgery. Activities and concentrations of tissue-plasminogen activator (tPA), plasminogen activator (PAI) type 1, and tPA/PAI complex were determined by ELISA kits. Results: There was no difference in age, sex, or body mass index between the two groups. Perioperative tPA activity decreased in both groups without differences between the groups. Concentrations and activities of tPA, PAI-1, and tPA/PAI complex did not differ between the groups at any time. Conclusion: Peritoneal concentrations and activities of tPA, PAI-1, and tPA/PAI complex are similar during laparoscopic and conventional colorectal resections. A capnoperitoneum of 12 mmHg over 3 h did not affect the peritoneal fibrinolytic activity [ABSTRACT FROM AUTHOR]

Focuses on the use of thoracic epidural catheter in randomized trials. Insertion of the catheter between T7 and T9; Role of the postoperative skin prick testing; Detection of differences with a two-sided test.