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Laparoscopically assisted colectomy and ileoanal pouch procedure with and without protective ileostomy

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Abstract

Background: Apart from an obviously better cosmetic situation, there is controversy on the actual benefit of laparoscopic and laparoscopically assisted techniques in restorative proctocolectomy. The need for a protective ileostomy remains unclear. Methods: Fifty-nine consecutive patients with ulcerative colitis and familial polyposis were included in this prospective cohort study. The colon was mobilized laparoscopically with a four-trocar technique, facilitating vascular dissection, rectal resection, and ileoanal pouch construction to be done through a Pfannenstiel incision. A protective ileostomy was constructed only in patients where the operation was difficult or where the anastomosis was under tension. Intra- and postoperative data were recorded; statistical analyses were performed by exact logistic regression. Results: Laparoscopic mobilisation was successful in 54 patients (91.2%). Two patients had to be primarily converted because of exceeding the set time limit; 3 other patients had to have an additional median laparotomy. These 5 patients all had an increased body mass index (BMI), which was a statistically significant risk factor for failure of the laparoscopic technique. 18.6% of patients developed major complications (n = 11). Nine patients required secondary ileostomies; all of them either were under high dose immunosuppressants (n = 5) or had an increased BMI (average 28.42 kg/m2). Failure of the laparoscopic technique was associated with major complications. Conclusion: Laparoscopically assisted restorative proctocolectomy is technically feasible; an increased BMI is a relevant risk factor for failure. The minimally invasive approach probably does not reduce the need for a protective ileostomy in selected patients. The selection criteria for the addition or omission of a protective ileostomy in minimally invasive restorative proctocolectomy remain to be clearly defined.

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Authors and Affiliations

  1. Surgical Department, University of Heidelberg, INF 110, 69120 Heidelberg, Germany

    P. Kienle, J. Weitz, C. Herfarth & J. Schmidt

  2. Central Unit Biostatistics, German Cancer Research Center (DKFZ), INF 280, 69120 Heidelberg, Germany

    A. Benner

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  1. P. Kienle
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  2. J. Weitz
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  3. A. Benner
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  4. C. Herfarth
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  5. J. Schmidt
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Correspondence to P. Kienle.

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Kienle, P., Weitz, J., Benner, A. et al. Laparoscopically assisted colectomy and ileoanal pouch procedure with and without protective ileostomy . Surg Endosc 17, 716–720 (2003). https://doi.org/10.1007/s00464-002-9159-1

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  • DOI: https://doi.org/10.1007/s00464-002-9159-1

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