Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients.
BACKGROUND
Ileal pouch-anal anastomosis (IPAA) is the recommended procedure for ulcerative colitis and profuse familial adenomatous polyposis. The aims of this study were to report a consecutive series of 82 unselected patients who undergone a total laparoscopic IPAA with a special focus on the postoperative morbidity and 1-year functional results.


METHODS
Between 2002 and 2008, 82 consecutive patients undergoing IPAA under a total laparoscopic approach were enrolled. Patient data, surgical procedure, and 1-year functional outcome were analyzed.


RESULTS
Among the 82 patients, 44 (54%) had a former subtotal colectomy (STC) before IPAA. No patient died postoperatively. Conversion rate was 11%. Overall morbidity was 32%. Symptomatic anastomotic fistulas were observed in nine patients (10%). Reoperation was needed in 5/82 (6%) of the patients. One-year functional results were 4.7 +/- 1.9 during the day and 1 +/- 1.2 during the night. Operating time decreased significantly after the first 40 laparoscopic IPAA (p = 0.0183). No difference was observed in the morbidity and functional results between patients operated for IPAA after a former colectomy or during a restorative proctocolectomy.


CONCLUSIONS
This study suggested the feasibility and safety of the total laparoscopic approach IPAA. Total laparoscopic approach could become the best approach for IPAA. Prior colectomy does not modify the result of this demanding surgical procedure.
Lefevre
Jérémie H
JH
Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France.
Bretagnol
Frédéric
F
Ouaïssi
Mehdi
M
Taleb
Philippe
P
Alves
Arnaud
A
Panis
Yves
Y
D011125:Adenomatous Polyposis Coli / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy; D039021:Colonic Pouches; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult