Top

Surgical Endoscopy

Published in:

01-10-2011

Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy?

Authors: Jinyu Gu, Luca Stocchi, Daniel P. Geisler, Ravi P. Kiran

Published in: Surgical Endoscopy | Issue 10/2011

Abstract

Background

The aim of this study was to compare outcomes of laparoscopic and open completion proctectomy (CP) and ileal-pouch anal anastomosis (IPAA) after a previous laparoscopic subtotal colectomy (STC).

Methods

From a prospectively maintained ileal pouch database, outcomes for patients who underwent laparoscopic CP after laparoscopic STC (LSTC-LCP group) for ulcerative or indeterminate colitis were compared to those for patients who underwent open CP (LSTC-OCP group). A control group of open CP after open STC (OSTC-OCP group) was case-matched to LSTC-OCP at a ratio of 1:2 for age at surgery, gender, body mass index (BMI), year of operation, and American Society of Anesthesiologists (ASA) classification. Demographics, perioperative data, and pouch function were compared. Quality of life was evaluated using the Cleveland Global Quality of Life Scale (CGQL).

Results

Between 1997 and 2009, 47 patients underwent LSTC followed by LCP (LSTC-LCP), and 48 patients underwent OCP after LSTC (LSTC-OCP); the latter group was matched to 96 open-open patients (OSTC-OCP). There were no significant differences in demographic and preoperative data among the three groups, except that the OSTC-OCP group patients were younger. Postoperative morbidity, pouch function, and CGQL were similar. LSTC-LCP patients had lower estimated blood loss (EBL) (p < 0.001), less commonly described intraoperative adhesiolysis (p < 0.001), reduced length of hospital stay (LOS) (p = 0.002) but longer operating time (p = 0.001) at CP/IPAA when compared with open-open patients. For patients with previous LSTC, LCP was associated with less commonly described intraoperative adhesiolysis (p = 0.003) and shorter LOS (p = 0.003) than OCP but a longer operating time (p = 0.036).

Conclusions

Laparoscopic CP and IPAA can be performed with safety comparable to that of open surgery after previous laparoscopic STC. The laparoscopic approach is associated with advantages including reduced intraoperative blood loss and earlier recovery as demonstrated by shorter length of hospital stay.

Pascual M, Alonso S, Parés D, Courtier R, Gil MJ, Grande L, Pera M (2011) Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer. Br J Surg 98:50–59PubMedCrossRef

Indar AA, Efron JE, Young-Fadok TM (2009) Laparoscopic ileal pouch-anal anastomosis reduces abdominal and pelvic adhesions. Surg Endosc 23:174–177PubMedCrossRef

da Luz Moreira A, Kiran RP, Kirat HT, Remzi FH, Geisler DP, Church JM, Garofalo T, Fazio VW (2010) Laparoscopic versus open colectomy for patients with American Society of Anesthesiology (ASA) classifications 3 and 4: the minimally invasive approach is associated with significantly quicker recovery and reduced costs. Surg Endosc 24:1280–1286PubMedCrossRef

Mor IJ, Vogel JD, da Luz Moreira A, Shen B, Hammel J, Remzi FH (2008) Infliximab in ulcerative colitis is associated with an increased risk of postoperative complications after restorative proctocolectomy. Dis Colon Rectum 51:1202–1207PubMedCrossRef

Selvasekar CR, Cima RR, Larson DW, Dozois EJ, Harrington JR, Harmsen WS, Loftus EV Jr, Sandborn WJ, Wolff BG, Pemberton JH (2007) Effect of infliximab on short-term complications in patients undergoing operation for chronic ulcerative colitis. J Am Coll Surg 204:956–962PubMedCrossRef

Parks AG, Nicholls RJ (1978) Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 2:85–88PubMedCrossRef

Hyman NH, Cataldo P, Osler T (2005) Urgent subtotal colectomy for severe inflammatory bowel disease. Dis Colon Rectum 48:70–73PubMedCrossRef

Dinnewitzer AJ, Wexner SD, Baig MK, Oberwalder M, Pishori T, Weiss EG, Efron J, Nogueras JJ, Vernava AM 3rd (2006) Timing of restorative proctectomy following subtotal colectomy in patients with inflammatory bowel disease. Colorectal Dis 8:278–282PubMedCrossRef

Dunker MS, Bemelman WA, Slors JF, van Hogezand RA, Ringers J, Gouma DJ (2000) Laparoscopic-assisted vs open colectomy for severe acute colitis in patients with inflammatory bowel disease (IBD): a retrospective study in 42 patients. Surg Endosc 14:911–914PubMedCrossRef

10.

Marcello PW, Milsom JW, Wong SK, Brady K, Goormastic M, Fazio VW (2001) Laparoscopic total colectomy for acute colitis: a case–control study. Dis Colon Rectum 44:1441–1445PubMedCrossRef

11.

Marceau C, Alves A, Ouaissi M, Bouhnik Y, Valleur P, Panis Y (2007) Laparoscopic subtotal colectomy for acute or severe colitis complicating inflammatory bowel disease: a case-matched study in 88 patients. Surgery 141:640–644PubMedCrossRef

12.

McAllister I, Sagar PM, Brayshaw I, Gonsalves S, Williams GL (2009) Laparoscopic restorative proctocolectomy with and without previous subtotal colectomy. Colorectal Dis 11:296–301PubMedCrossRef

13.

Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608PubMedCrossRef

14.

Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ (2001) Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 44:1800–1807PubMedCrossRef

15.

Larson DW, Dozois EJ, Piotrowicz K, Cima RR, Wolff BG, Young-Fadok TM (2005) Laparoscopic-assisted vs. open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48:1845–1850PubMedCrossRef

16.

El-Gazzaz GS, Kiran RP, Remzi FH, Hull TL, Geisler DP (2009) Outcomes for case-matched laparoscopically assisted versus open restorative proctocolectomy. Br J Surg 96:522–526PubMedCrossRef

17.

Kiran RP, Kirat HT, Ozturk E, Geisler DP, Remzi FH (2010) Does the learning curve during laparoscopic colectomy adversely affect costs? Surg Endosc 24:2718–2722PubMedCrossRef

18.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef

19.

Seshadri PA, Poulin EC, Schlachta CM, Cadeddu MO, Mamazza J (2001) Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages? Surg Endosc 15:837–842PubMedCrossRef

20.

Holubar SD, Larson DW, Dozois EJ, Pattana-Arun J, Pemberton JH, Cima RR (2009) Minimally invasive subtotal colectomy and ileal pouch-anal anastomosis for fulminant ulcerative colitis: a reasonable approach? Dis Colon Rectum 52:187–192PubMedCrossRef

21.

Chung TP, Fleshman JW, Birnbaum EH, Hunt SR, Dietz DW, Read TE, Mutch MG (2009) Laparoscopic vs. open total abdominal colectomy for severe colitis: impact on recovery and subsequent completion restorative proctectomy. Dis Colon Rectum 52:4–10PubMedCrossRef

22.

Ouaissi M, Lefevre JH, Bretagnol F, Alves A, Valleur P, Panis Y (2008) Laparoscopic 3-step restorative proctocolectomy: comparative study with open approach in 45 patients. Surg Laparosc Endosc Percutan Tech 18:357–362PubMedCrossRef

23.

Maartense S, Dunker MS, Slors JF, Gouma DJ, Bemelman WA (2004) Restorative proctectomy after emergency laparoscopic colectomy for ulcerative colitis: a case-matched study. Colorectal Dis 6:254–257PubMedCrossRef

24.

Fowkes L, Krishna K, Menon A, Greenslade GL, Dixon AR (2008) Laparoscopic emergency and elective surgery for ulcerative colitis. Colorectal Dis 10:373–378PubMedCrossRef

25.

Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. Br J Surg 95:909–914PubMedCrossRef

26.

Ahmed Ali U, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, van Laarhoven CJ (2009) Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev 1:CD006267

27.

Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243:667–670PubMedCrossRef

28.

Fichera A, Silvestri MT, Hurst RD, Rubin MA, Michelassi F (2009) Laparoscopic restorative proctocolectomy with ileal pouch anal anastomosis: a comparative observational study on long-term functional results. J Gastrointest Surg 13:526–532PubMedCrossRef

Title: Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy?
Authors: Jinyu Gu
Luca Stocchi
Daniel P. Geisler
Ravi P. Kiran
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 10/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-011-1707-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2011

Assessment of a simple, novel endoluminal method for gastrotomy closure in NOTES

Laparoscopic resection of the uncinate process of the pancreas: the inframesocolic approach and hanging maneuver of the mesenteric root

Laparoscopic repair of intrathoracic liver herniation after traumatic rupture of the diaphragm

Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study

Efficiency and outcomes of harmonic device in transanal endoscopic microsurgery compared with monopolar scalpel

Laparoscopic fixation of biologic mesh at the hiatus with fibrin or polyethylene glycol sealant in a porcine model