Laparoscopic versus open 2-stage ileal pouch: laparoscopic approach allows for faster restoration of intestinal continuity.
BACKGROUND
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis and familial adenomatous. This study examined the impact of the surgical approach (laparoscopic versus open) to IPAA on short-term outcomes and time to ileostomy closure in 2-stage restorative proctocolectomies.


METHODS
A retrospective review was performed on a prospectively maintained database at Washington University School of Medicine for patients undergoing elective 2-stage restorative proctocolectomy and IPAA from April of 1999 through July of 2008. Outcomes for patients were analyzed according to laparoscopic versus open technique.


RESULTS
A total of 124 patients (55 laparoscopy, 69 open) were included in this study. Laparoscopic IPAA took, on average, 79.2 minutes longer to complete than open IPAA (p < 0.0001) and required significantly more intravenous fluid administration (p = 0.0004). There was no significant difference between laparoscopic and open IPAA with respect to estimated blood loss, blood transfusions, postoperative narcotic usage, return of bowel function, length of stay, and hospital readmission rates. Total complications were not statistically significant between the 2 groups. Patients in the laparoscopic IPAA group underwent ileostomy closure an average of 24.1 days sooner than patients in the open group (p = 0.045). Multivariate analysis revealed that surgical approach (p = 0.018) and length of stay (p = 0.004) were associated with faster time to closure of loop ileostomy.


CONCLUSIONS
Laparoscopic IPAA is safe, with postoperative morbidity comparable with open IPAA. Laparoscopic IPAA can lead to faster recovery and result in faster progression to restoration of intestinal continuity in patients undergoing 2-stage restorative proctocolectomy.
Fajardo
Alyssa D
AD
Department of Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, St Louis, MO, USA.
Dharmarajan
Sekhar
S
George
Virgilio
V
Hunt
Steven R
SR
Birnbaum
Elisa H
EH
Fleshman
James W
JW
Mutch
Matthew G
MG
D011125:Adenomatous Polyposis Coli / Q000503:physiopathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003093:Colitis, Ulcerative / Q000503:physiopathology / Q000601:surgery; D039021:Colonic Pouches / Q000009:adverse effects; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007081:Ileostomy; D007422:Intestines / Q000503:physiopathology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016737:Proctocolectomy, Restorative; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult