Laparoscopic anterior lumbar fusion

To assess the feasibility and complications of the laparoscopic approach to anterior lumbar fusion and to evaluate the ability of metoclopramide in conjunction with preoperative bowel preparation and early oral feeding to decrease postoperative ileus and reduce the length of hospital stay. Laparoscopic anterior lumbar fusion was performed on 30 patients with persistent back pain between September 1997 and March 1999. All patients received metoclopramide 10 mg intravenously preoperatively and every 6 hours postoperatively, then 10 mg orally every 8 hours for 7 days. An experienced laparoscopic surgeon exposed the disc space, and lumbar fusion was performed by a neurosurgeon or an orthopedic surgeon. One procedure in an obese patient was converted to open surgery. The average operating time for the remaining patients was 2 hours 23 minutes. The average estimated blood loss was 75 mL. The only intraoperative complication was a trocar injury to the bladder. The average hospital stay was 2.3 days. In properly selected patients, laparoscopic anterior lumbar fusion with metoclopramide, preoperative bowel preparation, and early oral feeding results in a short hospital stay and yields better cosmetic results than traditional surgery.