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Yuu et al. Laparoscopic surgery for psychotic

Table 3: Intraoperative and postoperative outcomes
Characteristics LS (n = 16) OS (n = 15) P-value
Operation time (min) * 193.5 (125-459) 155 (78-483) 0.188
Blood loss (mL) * 27 (10-1907) 330 (34-2197) 0.001
Intraoperative transfusion 2 (12.5 %) 8 (53.3 %) 0.015
Type of resection 0.171
Right hemicolectomy 3 (18.8%) 6 (40.0%)
Transverse colectomy 1 (6.3%) 1 (6.7%)
Left hemicolectomy 1 (6.3%) 0 (0%)
Sigmoidectomy 7 (43.8%) 3 (20.0%)
Low anterior resection 3 (18.8%) 1 (6.7%)
Abdominal perineal resection 0 (0%) 3 (20.0%)
Total pelvic exenteration 1 (6.3%) 0 (0%)
Colostomy 0 (0%) 1 (6.7%)
Conversion to open surgery 2 (12.5%) - -
Stoma 1 (6.3%) 4 (26.7%) 0.122
Duration of drainage (days) * 8 (0-13) 8 (7-27) 0.175
Physical restraint 15 (93.8%) 15 (100%) 0.325
Physical restraint (days) * 19.5 (0-96) 28 (9-141) 0.110
Recovery of bowel motility (days) * 2 (1-6) 7 (2-25) < 0.001
Washout period (days) * 2.5 (1-6) 8 (4-35) < 0.001
Return to diet (days) * 5.5 (2-12) 9 (7-39) 0.155
Incidence of using additional analgesia, n (%) 3 (18.8%) 6 (40.0%) 0.252
Unscheduled Intravenous injections of psychotropic drugs 4 (25.0%) 7 (46.7%) 0.208
Duration of hospital stay after surgery (days) * 43 (18-144) 69 (29-423) 0.021
*Value are the median (range). LS: laparoscopic surgery; OS: open surgery

injections of psychotropic drugs were required for stage. Eighteen of 31 (58.1%) patients were diagnosed
these patients. Such injections usually involved as having stage III or IV disease. Four patients in the LS
haloperidol, levomepromazine maleate, or diazepam group had macroscopic residual tumors. Three of these
or a combination of these drugs, as determined by patients had liver metastasis, and the other patient had
the attending psychiatrist. The proportion of patients para-aortic lymph node metastasis. No patients received
who needed unscheduled intravenous injections of adjuvant or postoperative chemotherapy.
psychotropic drugs did not differ significantly between
the OS and LS groups. Physical restraints were applied In the OS group, 4 patients had macroscopic residual
for median periods of 19.5 days in the LS group and 28 tumors. Three of these patients had peritoneal
days in the OS group; the difference was not significant metastasis. The remaining patient underwent colostomy
(P = 0.110). because of direct invasion of the sacrum.

Complications DISCUSSION
Postoperative complications occurred in 6 patients
(37.5%) in the LS group and 9 (60.0%) in the OS group The number of patients receiving medical treatment
(P = 0.318). Major complications, which were defined from psychiatrists in Japan has increased over the past
as those that were more severe than Clavien-Dindo three decades. Moreover, the number of elderly patients
class III, occurred in 2 patients in the LS group and with psychiatric disorders has increased nine-fold during
4 in the OS group. One patient died (of pulmonary the same period. Psychiatric patients are not considered
embolism 2 days postoperatively) in the LS group, and to be at greater risk of digestive disease that requires
2 patients died (one died of sepsis due to anastomotic operation than the general population [13] . Therefore,
leakage 105 days postoperatively, and the other died Japanese surgeons are increasingly having to perform
of acute liver failure due to liver metastasis 80 days operation in psychiatric patients. We have performed
postoperatively) in the OS group. Mortality rates of the various surgical procedures for digestive disease in
two groups did not differ significantly [Table 4]. patients with psychiatric disorders, and we started
performing LS at the Tokyo Metropolitan Matsuzawa
Pathological outcomes Hospital in 2014.
Table 5 shows the pathological outcomes of both groups.
There were no significant differences between the groups There have only been a few reports about digestive
with respect to the tumor size, histological grade, or final surgery in patients with psychiatric disorders, and none

176 Mini-invasive Surgery ¦ Volume 1 ¦ December 28, 2017