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Yuu et al. Laparoscopic surgery for psychotic

peristalsis, even for psychiatric patients.

This study had several limitations. First, it had a
retrospective study design that has the inherent
weakness of being observational or non-experimental.
Second, the follow-up period was too short to enable
us to draw any conclusions regarding the long-term
outcomes of the LS or OS group. However, by continuing
to enroll and follow-up with patients, we hope to obtain
more valuable information in the future. Third, the small
number of subjects is the main limitation, as this may
have affected the results of the parameters. The Tokyo
Figure 1: Almost all of patients had megacolon, owing to psychiatric Metropolitan Matsuzawa Hospital is one of the largest
medicine and some purgative medicine mental hospitals in Tokyo. Yet, there are about 20
patients who have colorectal cancer in 1 year, so it was
have several short-term advantages compared with OS, difficult to include more psychiatric patients with cancer
e.g., it may contribute to reducing the hospitalization in our study.
period. According to some reports, institutionalized
patients tend to be hospitalized for longer, increasing the In conclusion, in agreement with a previous study that
cost of surgical treatment for this population [6,18] . In our found that patients with psychiatric disorders do not
study, the median hospitalization period was 43 days in represent a high-risk group during surgical treatment [13] ,
the LS group. One of the factors delaying the discharge we consider that such patients do not have worse
of psychiatric patients is the difficulty that such patients outcomes after LS than after OS for colorectal cancer.
have with adjusting to their environment. Patients with Our study demonstrated that LS for psychiatric patients
psychiatric problems cannot return to the psychiatric is safe, and it has comparable short-term outcomes and
department or support facilities immediately after oncological results compared to OS. Psychiatric patients
recovering from surgical stress. Collaboration with social might not need special postoperative managements,
workers may help reduce the hospitalization period by excluding treatment for psychiatric problems. Further
increasing clinicians’ understanding of the optimal studies involving more patients and a longer follow-up
management methods for patients with psychiatric period are needed to confirm the present study’s results.
disorders.
DECLARATIONS
The washout period was significantly shorter in the LS
group than in the OS group. This suggests that psychiatric Acknowledgments
medications should be continued, if possible, during the We grateful thanks to Dr. Masahiko SAITO, the president
perioperative period . Until LS was introduced, patients of the metropolitan Matsuzawa Hospital and Dr. Naoto
[6]
at our hospital routinely received a nasogastric tube for EGAWA who is the president of the Tokyo Metropolitan
a week postoperatively. The recovery of bowel motility Hiroo Hospital. We would also like to thank Editage
is more difficult in psychiatric patients than in general (www.editage.jp) for English language editing.
patients. After starting LS, the nasogastric tube was
removed immediately postoperatively [19] . The recovery Authors’ contributions
of bowel motility postoperatively was assessed by Concept, design, definition and intellectual content of
a surgeon, auscultation, or other physical findings. this study: K. Yuu, M. Tada
Therefore, psychiatric medications were resumed Operated this series: K.Yuu, Nasry Baongoc, M Tada
as soon as possible. Increased rates of delirium and Analysis, statistical analysis of this study: K. Yajima, K.
confusion in the postoperative period have been Yuu
reported in psychiatric patients. In surgical, medical, Manuscript preparation: K. Yuu
and critically ill patients, delirium is associated with Data acquisition: K Yuu, K Tsuchihashi, M Ogawa, M
higher mortality, a longer hospital stay, and impairment Kawasaki and M Kameyama
at discharge [4,5] . Some studies have suggested that the The paper was coauthored by Kazuhito Yajima,
postoperative development of confusion, delirium, or Masanori Tada, Nasry Baongoc, Kurumi Tsuchihashi,
cognitive disorders may have important consequences Masao Ogawa, Masayasu Kawasaki and Masao
for health care utilization and patient outcomes [20,21] . Kameyama. All authors’ meets the authorship criteria
LS may lead to a more rapid recovery of intestinal detailed in the Authorship section of this guideline and

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