Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study

Abstract

Background: Laparoscopic colonic surgery has been claimed to hasten recovery and reduce hospital stay compared with open operation. Recently, enforced multimodal rehabilitation (fast-track surgery) has improved recovery and reduced hospital stay in both laparoscopic and open colonic surgery. Since no comparative data between laparoscopic and open colonic resection with multimodal rehabilitation are available, the value of laparoscopy per se is unknown.

Methods: In a randomized, observer-and-patient, blinded trial, 60 patients (median age 75 years) underwent elective laparoscopic or open colonic resection with fast-track rehabilitation and planned discharge after 48 hours. Functional recovery was assessed in detail during the first postoperative month.

Results: Median postoperative hospital stay was 2 days in both groups, with early and similar recovery to normal activities as assessed by hours of mobilization per day, computerized monitoring of motor activity assessed, pulmonary function, cardiovascular response to treadmill exercise, pain, sleep quality, fatigue, and return to normal gastrointestinal function. There were no significant differences in postoperative morbidity, mortality, or readmissions, although 3 patients died in the open versus nil in the laparoscopic group.

Conclusion: Functional recovery after colonic resection is rapid with a multimodal rehabilitation regimen and without differences between open and laparoscopic operation. Further large-scale studies are required on potential differences in serious morbidity and mortality.

Figures

FIGURE 1. Primary hospital stay after open and laparoscopic colonic resection (P > 0.05 between groups). † indicates mortality.

FIGURE 2. Mobilization, physical activity (Actigraph), fatigue and sleep quality, and daily and leisure activity after open or laparoscopic colonic resection (P > 0.05 between groups at all intervals, except for sleep quality; * = P < 0.05). Changes in pulmonary function (FEV1, FVC, and PEF) showed a statistical decrease in both groups (Friedman test). Wilcoxon test shows that FEV1 was back to preoperative values 48 hours postoperatively in the open group and FVC and PEF on day 8. In the laparoscopic group, FEV1 returned to be preoperative values 8 days postoperatively, but not FVC and PEF.