Feasibility of laparoscopic restorative proctocolectomy without diverting stoma.
OBJECTIVE
Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy.


METHODS
Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database.


RESULTS
Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma.


CONCLUSIONS
Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.
Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris VI, Paris, France.
Thévy
T
Hor
Stéphane
S
Zalinski
Jérémie H
JH
Lefevre
Conor
C
Shields
Emmanuel
E
Attal
Emmanuel
E
Tiret
Yann
Y
Parc
D000293:Adolescent; D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome; D055815:Young Adult