title: Totally laparoscopic total proctocolectomy: a safe alternative to open surgery in inflammatory bowel disease.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) patients have a high incidence of wound and overall postoperative complications. A totally laparoscopic approach could potentially reduce these risks. We adopted totally laparoscopic total proctocolectomy (TL-TPC) using the perineal wound for extraction as the procedure of choice in IBD patients who are not candidates for a restorative procedure. This study looks at the TL-TPC results and compares them with our open cohort.
  
  
  METHODS
  Prospectively collected data from 52 consecutive patients undergoing TL-TPC from 2002 to 2010 were compared to 31 contemporary patients undergoing open TPC.
  
  
  RESULTS
  Demographics and patient characteristics including body mass index were similar. Mean operative times were 340 ± 7 minutes for TL-TPC and 337 ± 9 minutes for open TPC (P = 0.91). Intraoperative blood loss was 228 ± 2 mL for TL-TPC and 484 ± 3 mL for open TPC (P < 0.001). Return of bowel function measured as an ileostomy output >100 mL per 8 hours occurred at 2.7 ± 2.8 days for TL-TPC versus 3.3 ± 1.8 days for open TPC (P = 0.025). The length of stay was 8.4 ± 5.0 days for TL-TPC versus 9.2 ± 3.2 days for open TPC (P = 0.05). The overall complication rate was 43% for TL-TPC versus 65% for open TPC (P = 0.07). Postoperative abdominal wound infections and parastomal hernias occurred in 23% and 10% of open TPC patients, respectively, versus zero (P = 0.001) and 6% (P = 0.67) for TL-TPC.
  
  
  CONCLUSIONS
  TL-TPC is therefore considered a safe alternative to open surgery for selected IBD patients not candidates for a restorative procedure.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Holder-Murray
authors.forename: Marco
authors.initials: M
authors.lastname: Zoccali
authors.forename: Roger D
authors.initials: RD
authors.lastname: Hurst
authors.forename: Konstantin
authors.initials: K
authors.lastname: Umanskiy
authors.forename: Michele
authors.initials: M
authors.lastname: Rubin
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
mesh_terms: D003082:Colectomy; D003093:Colitis, Ulcerative / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors