Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial.
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.
Maartense
Stefan
S
Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Dunker
Michalda S
MS
Slors
J Frederick
JF
Cuesta
Miguel A
MA
Gouma
Dirk J
DJ
van Deventer
Sander J
SJ
van Bodegraven
Ad A
AA
Bemelman
Willem A
WA
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