Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization?
Previous data have suggested that laparoscopic colon and rectal surgery may shorten the length of hospitalization. These claims have been attributed to a reduction of the length of ileus. The definition of "ileus" is variable and in all cases is subjective. In this study it was defined as the length of time until the patient passed flatus or stool without nausea, vomiting or abdominal distention. This prospective study was undertaken to compare the duration of ileus and of hospitalization after laparoscopic-assisted (LAC) and standard laparotomy (SC). After restorative proctocolectomy with an ileal-pouch anal anastomosis (IPAA) in both sets of patients. Twenty-two patients underwent LAC and 20 age, sex, and diagnosis-matched controls underwent SC. Mucosal ulcerative colitis (MUC) was the diagnosis in 16 LAC and in 15 SC patients while polyposis was the diagnosis in 6 LAC and in 5 SC patients. The mean time to resolution of postoperative ileus was 4.2 (4-11) days in the LAC group and 3.3 (2-5) days in the SC group. Hospital discharge was similar in each group occurring at a mean of 8.7 (7-13) days after LAC and 8.9 (6-18) days after SC. Neither the length of time for ileus resolution nor the length of hospitalization were reduced in the LAC group. Laparoscopic-assisted IPAA conferred none of the theoretical advantages associated with other laparoscopic procedures.
Schmitt
S L
SL
Department of Colorectal Surgery, Cleveland Clinic Florida, Ft. Lauderdale.
Cohen
S M
SM
Wexner
S D
SD
Nogueras
J J
JJ
Jagelman
D G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors