title: Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy.
abstract: OBJECTIVE
  This study was designed to compare short-term outcomes of laparoscopic vs. open total abdominal colectomy and end ileostomy for severe ulcerative colitis and to evaluate the impact of the initial surgical approach on subsequent operations for three-stage restorative proctocolectomy.
  
  
  METHODS
  Perioperative demographic and outcome data for patients with severe ulcerative colitis who underwent laparoscopic (n = 37) or open (n = 41) total abdominal colectomy at the initial stage of a three-stage restorative proctocolectomy were compared. Each stage was analyzed independently by using two-tailed t-tests and analysis of covariance.
  
  
  RESULTS
  Patients who underwent laparoscopic total abdominal colectomy had higher serum albumin (P = 0.0003), less inpatient narcotic usage (P = 0.0143), faster return of bowel function (P = 0.0001), and shorter length of stay (P = 0.039). There were no differences in perioperative parameters for the restorative proctectomy and ileostomy closure. The laparoscopic total abdominal colectomy patients underwent subsequent restorative proctectomy 49 days sooner (P = 0.0044) and ileostomy closure 17 days sooner (P = 0.00003) than the open total abdominal colectomy patients.
  
  
  CONCLUSIONS
  Laparoscopic abdominal colectomy for severe ulcerative colitis in selected patients is safe and is associated with short-term benefits that may lead to faster recovery and progression to completion of restorative proctocolectomy.
authors.affiliation: Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: T Philip
authors.initials: TP
authors.lastname: Chung
authors.forename: James W
authors.initials: JW
authors.lastname: Fleshman
authors.forename: Elisa H
authors.initials: EH
authors.lastname: Birnbaum
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hunt
authors.forename: David W
authors.initials: DW
authors.lastname: Dietz
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Read
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Mutch
mesh_terms: D000293:Adolescent; D000328:Adult; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D055815:Young Adult