Laparoscopic restorative proctocolectomy.
BACKGROUND
Restorative proctocolectomy is increasingly being performed using minimally invasive surgery. In published series laparoscopically assisted techniques have usually included a suprapubic incision to enable major parts of the operation to be done openly.


METHODS
Fifty consecutive patients with familial adenomatous polyposis or ulcerative colitis underwent laparoscopic restorative proctocolectomy using only a small perumbilical incision of 4 cm or less for vascular dissection and pouch formation; all other steps were performed entirely laparoscopically. Logistic regression was used for statistical analysis.


RESULTS
In four patients (8 per cent) the operation was converted to an open procedure. The diagnosis of ulcerative colitis was associated with a higher overall rate of complications (P = 0.011), and an increased body mass index (BMI) with a higher rate of major complications (P = 0.050). The occurrence of wound infection was related to the diagnosis of ulcerative colitis (P = 0.049). Conversion resulted in greater blood loss (P = 0.004), but not in a higher complication rate. No patient required a blood transfusion. Patients with an increased BMI and those taking immunosuppressive therapy had a longer hospital stay (P = 0.043).


CONCLUSIONS
Laparoscopic restorative proctocolectomy is technically feasible. Patients with ulcerative colitis and increased BMI have a higher risk of complications. This minimally invasive technique may reduce the need for perioperative blood transfusion.
Kienle
P
P
Department of Surgery, University of Heidelberg, Heidelberg, Germany.
Z'graggen
K
K
Schmidt
J
J
Benner
A
A
Weitz
J
J
Büchler
M W
MW
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D003093:Colitis, Ulcerative / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012044:Regression Analysis; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome