Laparoscopic restorative proctocolectomy with ileal S-pouch.
OBJECTIVE
Restorative proctocolectomy has revolutionized the surgical management of ulcerative colitis and familial polyposis syndromes. Though now evolved to include laparoscopy, this approach has not included alternative pouch designs such as ileal S-pouch reconstruction. This comparative analysis evaluated the combination of laparoscopic-assisted total proctocolectomy with an ileal S-pouch design.


METHODS
One hundred fifty-six (65 laparoscopic-assisted) total proctocolectomy and ileal S-pouch-anal anastomosis procedures performed between 2003 to 2007 were identified from a prospective surgical database. Operative time, length of incision, length of hospital stay, complications, and return of bowel function were examined. A cost analysis including preoperative through postoperative hospital stay and operating room and postanesthesia care unit costs was performed.


RESULTS
The laparoscopic-assisted total proctocolectomy and ileal S-pouch-anal anastomosis procedures were performed for ulcerative colitis in 60 cases and familial adenomatous polyposis in the remaining 5 patients. Four conversions to open technique occurred (6 percent). Comparing laparoscopic and open procedures, the laparoscopic approach took longer to perform than the open technique (mean 451 minutes vs. 347 minutes open; P < 0.001). The mean hospital stay was 6.3 days in the laparoscopic group vs. 8.2 days in the open group (P < 0.001). A detailed cost analysis revealed similar overall costs between the laparoscopic ($18,700) and open approaches ($18,500).


CONCLUSIONS
Use of a laparoscopic total proctocolectomy with ileal S-pouch-anal anastomosis reconstruction minimizes incision size and shortens hospital stay. At a teaching academic institution, the laparoscopic approach requires longer operative times yet a negligible cost disadvantage.
Heise
Charles P
CP
Section of Colon and Rectal Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53592, USA. heise@surgery.wisc.edu
Kennedy
Gregory
G
Foley
Eugene F
EF
Harms
Bruce A
BA
D011125:Adenomatous Polyposis Coli / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches / Q000191:economics*; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000191:economics* / Q000379:methods*; D012189:Retrospective Studies