Comparative analysis between laparoscopic (UCL) and open (UCO) technique for the treatment of ulcerative colitis in pediatric patients.
OBJECTIVE
The aim of this study is to compare laparoscopic with open approach in the surgical treatment of ulcerative colitis (UC) MATERIAL AND METHODS: Between July 1991 and August 2009, 32 consecutive unselective patients with UC received surgical treatment. The population analyzed was divided into three groups: subtotal colectomy + ileocolostomy (Group 1), proctectomy + ileoanal pouch (Group 2), one-step proctocolectomy + ileoanal pouch (Group 3). We analyzed the mean operating time, postoperative oral intake, use of opiates, the length of hospital stay and postoperative morbidity in each group. Open and laparoscopic approaches were compared in each group retrospectively.


RESULTS
In Group 1 the mean operating time was longer for the laparoscopic group (301 vs. 197 min; p < 0.01). The length of postoperative stay was longer for the open group (8 vs. 19 days; p < 0.05) and the oral intake started earlier in the laparoscopic group (3, 5 vs. 6, 2 days; p = 0.05). No significant difference was found in the use of opiates (p = ns). A total of four major complications occurred in the laparoscopic group and another four in the open approach. In Group 2, there was no significant difference in operating time between laparoscopic and open approach. The laparoscopic group started earlier to tolerate (p < 0.05) and there were significantly differences in the use of narcotics and hospital stay (p < 0.05). General complications were related to the pouch. In Group 3 the mean operating time was longer for the laparoscopic group (470 vs. 330 min p < 0.05). Patients with a laparoscopic approach had a shorter hospital stay (5, 6 vs. 10 days; p < 0.05) and postoperative narcotic use and they started earlier to tolerate (p < 0.05). One major complication was presented in the laparoscopic procedure and two in the open approach.


CONCLUSIONS
Of the 165 patients with UC in our hospital, 32 underwent surgery. The laparoscopic approach seems feasible and safe. A single staged approach (Group 1 + Group 2) remains the most reasonable choice for most patients. One-step approach was done only in selected cases (Group 3). The advantages of laparoscopy, such as improved cosmetic aspects, shorter postoperative ileus and hospital stay, were observed in the laparoscopic colectomy, proctectomy and ileoanal pouch in our study.
Flores
P
P
J.P.Garrahan Children's Hospital, Buenos Aires, Argentina. paulaflores@fibertel.com.ar
Bailez
M M
MM
Cuenca
E
E
Fraire
C
C
D000293:Adolescent; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D003125:Colostomy; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
D000701:Analgesics, Opioid