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Laparoscopic restorative proctocolectomy

Case-matched comparative study with open restorative proctocolectomy

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Diseases of the Colon & Rectum


PURPOSE: A laparoscopic approach to restorative proctocolectomy is new and has not been compared recently with the traditional open procedure. By using prospectively gathered data, laparoscopic and open restorative proctocolectomy procedures in mucosal ulcerative colitis and familial adenomatous polyposis patients were compared by using a case-matched design. METHODS: Forty patients, composing 20 consecutive laparoscopic cases (13 mucosal ulcerative colitis, 7 familial adenomatous polyposis), were matched for age, gender, and body mass index with 20 open cases (13 mucosal ulcerative colitis, 7 familial adenomatous polyposis) performed during the same time period. Mucosal ulcerative colitis patients were also matched for severity of disease by using hemoglobin and albumin levels, whole blood count, and steroid dependency. A loop ileostomy was made in 12 of 13 laparoscopic mucosal ulcerative colitis patients, all open mucosal ulcerative colitis patients, and no familial adenomatous polyposis patients. RESULTS: The median age was 25 (range, 9–61) years. There were no intraoperative complications in either group and no conversions in the laparoscopic group. The operative times (median, range) were significantly longer in laparoscopic cases (330, 180–480 minutes)vs. open cases (230, 180–300 minutes),P<0.001. Bowel function returned more quickly in laparoscopic cases (2, 1–8 days)vs. open cases (4, 1–13 days),P=0.03; and the length of stay was shorter in laparoscopic cases (7, 4–14 days)vs. open cases (8, 6–17 days),P=0.02. For diverted patients, the median length of stay was reduced by two days in laparoscopic cases (6, 4–14 days)vs. open cases (8, 6–17 days),P=0.01. Complications occurred in 4 of 20 laparoscopic patients (3 obstruction/ileus and 1 pelvic abscess) and 5 of 20 open patients (2 obstruction and ileus, 1 each anastomotic leak and abscess, peptic ulceration, and episode of dehydration). CONCLUSIONS: Return of intestinal function and length of stay are reduced in the laparoscopic group compared with open group. A laparoscopic approach to restorative proctocolectomy has the potential of becoming an appealing alternative to conventional restorative proctocolectomy surgery.

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  1. Bohm B, Schwenk W. Results of prospective randomized trials of laparoscopic versus conventional resection for colorectal cancer [abstract] Int J Colorectal Dis 1998;13:179.

    Google Scholar 

  2. Stage JG, Schulze S, Moller P,et al. Prospective randomized study of laparoscopic versus open colonic resection for adenocarcinoma. Br J Surg 1997;84:391–6.

    Article  PubMed  Google Scholar 

  3. Milsom JW, Bohm B, Hammerhofer KA, Fazio V, Steiger E, Elson P. A prospective, randomized trial comparing laparoscopic versus conventional techniques in colorectal cancer surgery: a preliminary report. J Am Coll Surg 1998;187:46–54.

    Article  PubMed  Google Scholar 

  4. Marcello PW, Roberts PL, Schoetz DJ Jr, Murray JJ, Coller JA, Veidenheimer MC. Long-term results of the ileoanal pouch procedure. Arch Surg 1993;128:500–4.

    PubMed  Google Scholar 

  5. Fazio VW, Ziv Y, Church JM,et al. Ileal pouch-anal anastomoses complications and function in 1005 patients. Ann Surg 1995;222:120–7.

    PubMed  Google Scholar 

  6. Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG. Laparoscopic total abdominal colectomy: a prospective trial. Dis Colon Rectum 1992;35:651–5.

    Article  PubMed  Google Scholar 

  7. Schmitt SL, Cohen SM, Wexner SD, Nogueras JJ, Jagelman DG. Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis 1994;9:134–7.

    Article  PubMed  Google Scholar 

  8. Reissman P, Salky BA, Pfeifer J, Edye M, Jagelman DG, Wexner SD. Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg 1996;171:47–51.

    Article  PubMed  Google Scholar 

  9. Sardinha TC, Wexner SD. Laparoscopy for inflammatory bowel disease: pros and cons. World J Surg 1998;22:370–4.

    Article  PubMed  Google Scholar 

  10. Lui CD, Rolandelli R, Ashley SW, Evans B, Shin M, McFadden DW. Laparoscopic surgery for inflammatory bowel disease. Am Surg 1995;61:1054–6.

    PubMed  Google Scholar 

  11. Hildebrandt U, Lindemann W, Kreissler-Hagg D, Feifel G, Ecker KW. Laparoscopically-assisted proctocolectomy with ileoanal pouch in ulcerative colitis. Zentralbl Chir 1998;123:403–5.

    PubMed  Google Scholar 

  12. Milsom JW, Bohm B. Laparoscopic colorectal surgery. 1st ed. New York: Springer-Verlag, 1996.

    Google Scholar 

  13. Milsom JW, Ludwig KA, Church JM, Garcia Ruiz A. Laparoscopic total abdominal colectomy with ileorectal anastomosis for familial adenomatous polyposis. Dis Colon Rectum 1997;40:675–8.

    Article  PubMed  Google Scholar 

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Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.

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Marcello, P.W., Milsom, J.W., Wong, S.K. et al. Laparoscopic restorative proctocolectomy. Dis Colon Rectum 43, 604–608 (2000).

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