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ARE THE OLD WAYS STILL THE BEST?

Braga M, Frasson M, Vignali A, et al. Open right colectomy is still effective compared to laparoscopy: results of a randomized trial. Annals of Surgery 2007;246:1010–15.

Laparoscopic colorectal surgery has gained widespread acceptance in recent years. Concerns over safety, efficacy and potential benefits of the technique have been all but answered by a number of multicentre randomised trials. However, these trials have failed to look at the benefit of laparoscopic techniques for specific and relatively simple procedures such as right hemicolectomy. Current enhanced recovery programmes and modern open techniques have allowed many of the advantages of laparoscopic surgery to be applied to conventional surgery, potentially nullifying some of the perceived benefits. Berga et al set out to examine these ideas. Two hundred and twenty-six patients, candidates for right hemicolectomy, were randomised to a laparoscopic (n = 113) or an open (n = 113) resection. Other than this, the operative and postoperative care protocols were the same for both groups. Operative time (in minutes) was longer in the laparascopic group (131 vs 112, p = 0.01) but the postoperative morbidity rate was greater, 18.6% vs 13.3% (p = 0.31) and the postoperative stay one day longer in the open group (p = 0.002). No difference was found in postoperative quality of life between the two groups. From a cost–benefit point of view, the additional operative charge in the …

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