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Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis

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Abstract

Purpose

Randomized controlled trials (RCTs) demonstrated that a laparoscopic approach provides short-term benefits, such as reduced blood loss and a shorter hospital stay, in patients who undergo rectal surgery. On the other hand, a few RCTs investigating proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) suggested limited advantages of laparoscopic surgery over open surgery. A substantial proportion of patients with UC or FAP may undergo staged operations with IPAA, but no study has compared the two approaches for proctectomy with IPAA after total abdominal colectomy.

Methods

We examined 61 consecutive patients with UC or FAP who underwent proctectomy with IPAA after colectomy in our hospital. Patients were divided into the Lap group (n = 37) or the Op group (n = 24) according to surgical approach. Patient background and outcomes, such as operative time, blood loss, first bowel movement, postoperative complications, and pouchitis, were compared between these groups.

Results

One patient required conversion to open surgery in the Lap group. The median volume of blood loss was 90 mL in the Lap group and 580 mL in the Op group (p < 0.0001). The Lap group showed a shorter time to first bowel movement than the Op group (median: 1 vs 2 days, p = 0.0003). The operative time, frequencies of postoperative complications, and accumulation rate of pouchitis were similar between the two groups.

Conclusions

Laparoscopic surgery was beneficial for patients undergoing restorative proctectomy in terms of blood loss and bowel recovery without increasing the operative time or rate of complications.

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Availability of data and material

The datasets generated and/or analyzed during the current study are not publicly available because they are derived from the patient database of the hospital and hence subject to confidentiality, but are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

Hiroaki Nozawa is supported by Grants-in-Aid for Scientific Research from Japan Society for the Promotion of Science (Challenging Research (Exploratory): grant number: 20K21626, and B: grant number: 21H02778). Shigenobu Emoto is supported by Grants-in-Aid for Scientific Research from Japan Society for the Promotion of Science (C: grant number: 19K09115).

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Hiroaki Nozawa, Keisuke Hata, Kazuhito Sasaki, Koji Murono, Kazushige Kawai, Shigenobu Emoto & Soichiro Ishihara

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  1. Hiroaki Nozawa
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  2. Keisuke Hata
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  3. Kazuhito Sasaki
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  5. Kazushige Kawai
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  6. Shigenobu Emoto
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  7. Soichiro Ishihara
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Contributions

Study conception and design: HN, KH, and SI; acquisition of data: HN, KS, KM, KK, SE; analysis and interpretation of data: HN, KH, KS, and SI; drafting of manuscript: HN; critical revision of manuscript: KH, KS, KM, KK, SE, and SI

Corresponding author

Correspondence to Hiroaki Nozawa.

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Ethics approval

This study was conducted with the approval of the ethics committee of the University of Tokyo Hospital.

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For inclusion in the current study, written informed consent was obtained from all patients, and the opportunity to opt-out was also offered.

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All authors read and approved the present article and authorized its publication.

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The authors declare no competing interests.

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Nozawa, H., Hata, K., Sasaki, K. et al. Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis. Langenbecks Arch Surg 407, 1605–1612 (2022). https://doi.org/10.1007/s00423-022-02492-x

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  • DOI: https://doi.org/10.1007/s00423-022-02492-x

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