title: A laparoscopic approach does reduce short-term complications in patients undergoing ileal pouch-anal anastomosis.
abstract: BACKGROUND
  Studies to date examining the impact of laparoscopy in the IPAA have failed to demonstrate a significant, consistent benefit in terms of a reduction in short-term morbidity or length of stay.
  
  
  OBJECTIVE
  The aim of this study was to establish the impact of the operative approach (laparoscopic or open) on outcomes after IPAA formation.
  
  
  METHODS
  With use of the American College of Surgeons National Surgical Quality Improvement Program participant use file (2005-2008), the records of patients who underwent open or laparoscopic IPAA with diverting ileostomy were examined.
  
  
  METHODS
  Risk-adjusted 30-day outcomes and length of stay were assessed by use of regression modeling, adjusting for patient characteristics, comorbidities, and operative approach.
  
  
  RESULTS
  Six hundred seventy-six cases were included, of which 339 (50.1%) were laparoscopic procedures. After adjustment, a laparoscopic approach was associated with a lower rate of major (OR = 0.67, 95% CI: 0.45-0.99, P = .04) and minor (OR = 0.44, 95% CI: 0.27-0.70, P = .01) complications. Laparoscopy was not associated with a significant reduction in length of postoperative stay compared with open pouch formation (laparoscopic vs open approach, -0.05 ± 0.30 d (P = .87)).
  
  
  CONCLUSIONS
  The sampling strategy used by the National Surgical Quality Improvement Program means that only a proportion of all relevant cases would have been analyzed and no data are available about the potential impact of surgeon experience on outcome.
  
  
  CONCLUSIONS
  A laparoscopic approach to ileal pouch formation was associated with a significant reduction in both major and minor complications compared with the traditional open approach. Given the high financial costs associated with complications arising from this procedure, this study provides support for the adoption of the laparoscopic approach in the formation of an IPAA.
authors.affiliation: Division of Colorectal Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA. fergal_fleming@URMC.rochester.edu
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: Todd D
authors.initials: TD
authors.lastname: Francone
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kim
authors.forename: Douglas
authors.initials: D
authors.lastname: Gunzler
authors.forename: Susan
authors.initials: S
authors.lastname: Messing
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery; D039021:Colonic Pouches; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative