title: Laparoscopically assisted colectomy and ileoanal pouch procedure with and without protective ileostomy.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Surgical Department, University of Heidelberg, INF 110, 69120 Heidelberg, Germany. Peter_Kienle@med.uni-heidelberg.de
authors.forename: P
authors.initials: P
authors.lastname: Kienle
authors.forename: J
authors.initials: J
authors.lastname: Weitz
authors.forename: A
authors.initials: A
authors.lastname: Benner
authors.forename: C
authors.initials: C
authors.lastname: Herfarth
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods* / Q000706:statistics & numerical data; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods* / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure