Author/Editor		Korolija, D; Škegro, M; Vegar-Brozović, V; Markičević, A
Title		Laparoscopic sigmoid resection in an older patient with impaired renal function
Translated title		Laparoskopska resekcija sigme pri starostniku z okvarjenim delovanjem ledvic
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 9, št. 22
Publication year		2004
Volume		str. 31-5
Language		eng
Abstract		Background. The use of laparoscopic colorectal surgery has increased much in recent years. Its advantages, i.e. lesser surgical stress and reduced impact on the immune system, which have been recently reported in the literature, have encouraged surgeons to use the laparoscopic approach in older patients with serious co-morbidity. Patient and methods. A 78-year-old patient with sigmoid carcinorna was operated on via the laparoscopic approach. The patient had impaired renal function with average preoperative creatinine levels of 300 to 350 microm/I, and presented with symptoms of senile dementia and reduced respiratory function. Results. The tumor was located 20 cm from the anal verge. Central vascular ligation and disection of the mesocolon from the medial to the lateral side were performed according to the standard principles of laparoscopic sigmoid resection. The patient was intensively monitored intraoperatively and on the first postoperative day. Liquids were given on the first postoperative day. The creatinine levels increased to 400 micromol/L and returned to preoperative values five days after surgery. The patient required no renal support (dialysis) and was discharged from the hospital one week after surgery with a confirmed diagnosis of Stage III adenocarcinoma. Conclusion. The minimally invasive approach has proved appropriate for older patients with colonic cancer. The results of laparoscopic sigmoid resection performed in our patient confirmed the literature data on lesser surgical stress associated with minimally invasive techniques. In conclusion, laparoscopic surgery is applicable to older patients with serious co-morbidity.
Summary		Izhodišče. V zadnjih letih se povečuje število laparoskopskih operacij širokega črevesja in danke. Novejša poročila navajajo manjši negativen vpliv kirurškega posega na imunski sistem. To dejstvo je ohrabrilo kirurge, da vse češče uporabljajo laparoskopsko tehniko pri starejših bolnikih s spremljajočimi boleznimi. Bolnik in metode. Operirali smo laparoskopsko 78-letnega bolnika z rakom na sigmi. Bolnik je imel okvarjeno ledvično funkcijo s povprečno predoperacijsko vrednostjo kreatinina med 300 in 350 mmol/l. Imel je tudi znake senilne demence in zmanjšano zmogljivost dihal. Rezultat. Tumor se je nahajal v višini 20 cm od zadnjične odprtine. Po opravljeni centralni podvezavi žil je bila sigma izolirana po standardnih načelih laparoskopske tehnike. Med operacijo in prvi pooperacijski dan je bil bolnik intenzivno nadzorovan. Prvi dan po operaciji je pričel z uživanjem tekočine. Kreatinin se je dvignil na 400 mmol/1, peti dan po operaciji pa je padel na predoperacijske vrednosti. Dializa ni bila potrebna, En teden po operaciji je bil bolnik odpuščen iz bolnišnice. Histološko je bil potrjen stadij III žleznega raka sigme. Zaključek. Očitno je minimalno invazivna tehnika primerna za starejše bolnike s kolorektalnim rakom. Tudi v našem primeru se je pokazala prednost manjše kirurške obremenitve ob laparoskopski tehniki, ki jo zato priporočamo pri starejših bolnikih s težjimi spremljajočimi boleznimi.
Descriptors		SIGMOID NEOPLASMS LAPAROSCOPY KIDNEY FAILURE AGED