Estado actual de la cirugía laparoscópica del colon

The rapid acceptance of laparoscopic cholecystectomy into surgical practice has been followed by the extension of this surgical treatment to many other surgical problems. Currently acceptable and feasible laparoscopic intestinal resections include those for diagnostic procedures, Crohn's disease, ulcerative colitis, diverticulitis, familial polyposis, rectal prolapse, bening tumors, angiodysplasia of the colon, dolichocolon, iatrogenic colon perforation and palliative colorectal cancer surgery, etc. However, the efficacy of laparoscopic surgery for curative cancer surgery of colon and rectum remains unclear. On the other hand acute inflamation of colon due to benign disease as diverticulitis, and colonic obstruction represent a technical challenge that require appropiate skills due to the difficulties of dissection, in the first cases, and the difficulties of exposure because of the association of small bowel dilatation, in the second cases. Like any new technique, laparoscopic colon surgery must display results of the same or even better quality than established methods. All advantages of laparoscopic procedures are observed after the laparoscopic approach for the surgical treatment of colon disease, in form of less pain, earlier begining of bowel movements, faster return to full diet and earlier hospital discharge. Length of stay, complication rate, conversion rate and operating time decreased with experience suggesting that laparoscopic colorectal surgery presupposes knowledge in colorectal surgery of large bowel and also requires extensive experience in laparoscopic techniques. Education and training for the laparoscopic surgery of colon and rectum diseases include laboratory training, monitored experiences, and previous experiencies, being the base of the correct management of these procedures by this surgical approach. Laporoscopic surgery for the treatment of colorectal diseases has raised different controversies, most of them related to the use of the laparoscopic approach for cure colorectal malignancy. Application of laparoscopic surgery for cure colorectal malignancy must be approached with caution. Thus, at present, curative laparoscopic oncologic surgery for colon and rectum carcinoma must be discussed based on prospective, randomized clinical trial. Differents reports suggest that the laparoscopic approach to colorectal resection is an acceptable alternative to laparotomy for a variety of disease processes