Impact of Patient’s Pain and Fatigue on Decision of Discharge After Laparoscopic Surgery for Colorectal Cancer

PURPOSE: Hospital stays after laparoscopic surgery for colorectal cancer tend to be much shorter than those after conventional open surgery. Many factors, including surgical outcomes and complications, are associated with patient discharge planning. However, few studies have analyzed the impact of patient subjective discomfort (including pain and fatigue) on the decision to discharge after surgery. Therefore, the purpose of this study was to determine how patient pain and fatigue play a role in the decision to discharge after laparoscopic surgery for colorectal cancer. METHODS: Between March 2014 and February 2015, we conducted a questionnaire survey of 91 patients who underwent laparoscopic surgery for colorectal cancer to estimate the expectation criteria for discharge and patient subjective discomfort at that time. Patients were divided into the following 2 groups: group A, those who complied with the medical professional’s decision to discharge; and group B, those who refused discharge despite the medical professional’s decision. The participants’ subjective factors were analyzed. RESULTS: Preoperatively, 78 of 91 patients (85.7%) identified activity level, amount of food (tolerance), and bowel movements as important factors that should be considered in the decision to discharge a patient postoperatively. Postoperatively, 17 patients (18.7%) refused discharge despite a discharge recommendation. Subjective pain and fatigue were significantly different in linear-by-linear association between the group of patients who agreed to be discharge and those who disagreed. Despite this difference, there was no significant difference in mean length of hospital stay between the 2 groups. CONCLUSION: A patient’s subjective feelings of pain and fatigue can impact their decision regarding hospital discharge.

Single-incision laparoscopic ileostomy is a safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection

PURPOSE: Currently, many operations are performed using the single-incision laparoscopic method. Although there have been recent reports on single-incision laparoscopic ileostomy, none have compared this method to conventional laparoscopic ileostomy. This study aimed to assess the safety and feasibility of single-incision laparoscopic ileostomy for anastomotic leakage following laparoscopic low anterior resections. METHODS: From April 2012 to April 2017, 38 patients underwent laparoscopic ileostomy (single-incision; 19 patients referred to as group A, conventional laparoscopy; 19 patients referred to as group B) for anastomotic leakage following laparoscopic low anterior resection. We analyzed surgical and clinical outcomes between the 2 groups. Patients in whom a protective ileostomy was carried out during the initial laparoscopic low anterior resection were excluded from this study. RESULTS: No significant differences were observed between the 2 groups in terms of patient demographics and initial operation details. Incisional surgical site infections occurred less in group A than in group B (2 of 19 vs. 9 of 19, P = 0.029). The median ileostomy operation time, amount of intraoperative bleeding, parastomal hernia ratio, hospital stay duration after ileostomy, postoperative pain score were not significantly different between the 2 groups. CONCLUSION: Single-incision laparoscopic ileostomy is safe and feasible method of fecal diversion for anastomotic leakage following laparoscopic low anterior resection.

Effect of Gum Chewing on the Recovery From Laparoscopic Colorectal Cancer Surgery

PURPOSE: We aimed to examine the effect of gum chewing after laparoscopic colorectal cancer surgery. METHODS: We reviewed the medical records of patients who underwent laparoscopic colorectal cancer surgery in Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine. We divided the patients into 2 groups: group A consisted of 67 patients who did not chew gum; group B consisted of 65 patients who chewed gum. We analyzed the short-term clinical outcomes between the two groups to evaluate the effect of gum chewing. RESULTS: The first passage of gas was slightly earlier in group B, but the difference was not significant. However, the length of hospital stay was 6.7 days in group B, which was significantly shorter than that in group A (7.3 days, P = 0.018). CONCLUSION: This study showed that length of postoperative hospital stay was shorter in the gum-chewing group. In future studies, we expect to elucidate the effect of gum chewing on the postoperative recovery more clearly.