La minilaparotomia trasversale come via di accesso nella patologia del colon destro: una valida alternativa alla laparotomia mediana.

AIMS OF THE STUDY: 1. To evaluate the feasibility and appropriateness of transverse right minilaparotomy for right colectomy and lymphadenectomy. 2. To identify the clinical advantages, if any, of this access route compared to the more traditional midline incision. PATIENTS: 44 patients with right colon adenocarcinoma undergoing colonic resection via a transverse or midline laparotomy. METHODS: The transverse incision starts 1 cm above the umbilicus, running from the midline to the anterior axillary line. RESULTS: 17 (39%) transverse minilaparotomies and 27 (51%) midline laparotomies were performed, respectively. The mean operative time was 107 min for patients with the transverse incision and 157 min. for those with midline laparotomy. Twelve out of 17 patients (70%) with the transverse incision experienced no or only mild pain as against 11 out of 27 patients (41%) with midline laparotomy. Bowel function was slightly faster in the first group of patients, though the difference was not statistically significant. Forty-seven percent of patients with transverse minilaparotomy were discharged within 8 days postoperatively as against 4% with midline laparotomy (P = 0.001). No major complications occurred in the first group, while 2 patients (7%) operated on via the midline laparotomy experienced complications (haemorrhage, deep venous thrombosis). CONCLUSION: Although this is a preliminary study in only 44 patients, our results support the idea that transverse minilaparotomy is a less traumatic access route to the right colon, in addition to offering an adequate exposure of the operative field, faster postoperative recovery and a shorter hospital stay. We believe it to be a good alternative to midline laparotomy for right colon surgery.