title: Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents.
abstract: BACKGROUND
  Laparoscopic techniques have been applied to restorative proctocolectomy since the early 2000's. We have employed a technique for laparoscopic-assisted total proctocolectomy (TPC) and ileal pouch anal anastomosis (IPAA) for the treatment of children with ulcerative colitis (UC).
  
  
  METHODS
  We retrospectively reviewed 68 laparoscopic-assisted TPCs and 39 open TPCs performed at our institution for UC between January 1997 and February 2011. Case duration, postoperative length of stay, and complications of the two groups were compared, and multivariable analysis was applied.
  
  
  RESULTS
  The two groups were comparable with respect to gender, age, and postoperative length of stay. Total abdominal colectomy (TAC) duration was significantly longer in the laparoscopic-assisted group (P < .001). Complications were similar in the laparoscopic and open group, although small bowel obstruction (SBO) was significantly less frequent in the laparoscopic group (log-rank test = 8.88, P = .003). Kaplan-Meier estimated freedom from SBO at 1 year follow-up is 99% for patients treated laparoscopically (95% CI: 98%-100%) and 76% for those undergoing an open surgical approach (95% CI: 64%-88%).
  
  
  CONCLUSIONS
  The significantly lower SBO rate, low complication rates, and equivalent length of stay favor use of the laparoscopic-assisted approach for TPC and IPAA in children.
authors.affiliation: Department of Surgery, Boston Children's Hospital-Harvard Medical School Boston, MA 02115, USA. bradley.linden@childrens.harvard.edu
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Linden
authors.forename: Sigrid
authors.initials: S
authors.lastname: Bairdain
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Craig W
authors.initials: CW
authors.lastname: Lillehei
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D039021:Colonic Pouches; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*; D012189:Retrospective Studies
keywords: Laparoscopy; Pediatric; Restorative proctocolectomy; Small bowel obstruction; Ulcerative colitis