Totally laparoscopic total proctocolectomy: a safe alternative to open surgery in inflammatory bowel disease.

Inflamm Bowel Dis 2012 May 14;18(5):863-8. Epub 2011 Jul 14.

Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA.

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.

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http://dx.doi.org/10.1002/ibd.21808DOI Listing
May 2012
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References

(Supplied by CrossRef)

Guillou et al.
Lancet 2005

Veldkamp et al.
Lancet Oncol 2005

Fichera et al.
J Gastrointest Surg 2009

Boushey et al.
Dis Colon Rectum 2007

Marcello et al.
Dis Colon Rectum 2000

Rivadeneira et al.
Dis Colon Rectum 2004

Larson et al.
Surg Endosc 2005

Peters et al.
J Laparoendosc Surg 1992

Thibault et al.
Surg Laparosc Endosc 1995

Seshadri et al.
Surg Endosc 2001

Holubar et al.
Inflamm Bowel Dis 2009

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