title: Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial.
abstract: OBJECTIVE
  The aim of the study was to evaluate postoperative recovery after hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis in a randomized controlled trial.
  
  
  METHODS
  Sixty patients were randomized for hand-assisted laparoscopic (n = 30) or open surgery (n = 30). Primary outcome parameter was postoperative recovery in the 3 months after surgery, measured by quality of life questionnaires (SF-36 and GIQLI). Secondary parameters were postoperative morphine requirement and surgical parameters, viz. operating time, morbidity, hospital stay, and costs.
  
  
  RESULTS
  There was no difference between the 2 procedures in quality of life assessment in the 3 months after surgery. There was a significant decline in quality of life on all scales of the SF-36 (P < 0.001) and total GIQLI score (P < 0.001) in the first 2 weeks in both groups (no significant difference between the groups). Quality of life returned to baseline levels after 4 weeks. Operating times were longer in the laparoscopic group compared with the open group (210 and 133 minutes, respectively; P < 0.001). No significant differences were found in morphine requirement. Neither morbidity nor postoperative hospital stay differed between the laparoscopic and open group (20% versus 17%, in 10 versus 11 days, respectively). Median overall costs were 16.728 for the hand-assisted laparoscopic procedure and 13.406 for the open procedure (P = 0.095).
  
  
  CONCLUSIONS
  Recovery measured using quality of life questionnaires is comparable for hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis. The laparoscopic approach is as safe, but more costly than the open procedure.
authors.affiliation: Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Maartense
authors.forename: Michalda S
authors.initials: MS
authors.lastname: Dunker
authors.forename: J Frederick
authors.initials: JF
authors.lastname: Slors
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Sander J
authors.initials: SJ
authors.lastname: van Deventer
authors.forename: Ad A
authors.initials: AA
authors.lastname: van Bodegraven
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000601:surgery; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care; D016737:Proctocolectomy, Restorative / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D013997:Time Factors