Introduction Laparoscopic colorectal surgery confers significant benefits over similar open procedures. A paucity of data exists examining this in restorative proctocolectomy, although recent literature has suggested reduced adhesions and improved fertility. We assessed consecutive patients undergoing laparoscopic ileal pouch anal anastomosis (IPAA), comparing clinical outcomes with those following conventional open surgery.
Methods 207 consecutive patients undergoing IPAA between November 2006 and November 2011 were assessed [76 (37%) laparoscopic procedures and 131 (67%) open cases were included]. A careful collaborative approach to developing the new technique was undertaken during the first two years in this high volume centre. Data were collected prospectively on a dedicated database. Study endpoints included post-operative length of stay, 30 day morbidity [Clavien-Dindo classification(C-D)], readmission, reoperation, pouch function & failure.
Results There were no significant differences in patient age, sex, BMI or previous abdominal surgery between the two groups. Conversion rate was 9%; Median operative time was significantly shorter for open surgery – 208 (IQR 178–255) versus 285 minutes (IQR 255–325); p < 0.0005. The duration of laparoscopic surgery decreased significantly during the study period.
Laparoscopy significantly reduced length of stay: median 6 days (IQR 4.25–8), v 8 days (IQR 7–12); p < 0.0005.
Minor [C-D I/II] complications were significantly reduced with laparoscopy (32.8% v 50.4%: OR 0.48 [95%CI 0.27–0.87]). Complications [all grades] were reduced non-significantly after laparoscopic surgery There were no significant differences in total complications – 51.3% after laparoscopy versus 61.5%: OR 0.66 [95%CI 0.37–1.17], anastomotic leak rate, major morbidity, 30 day readmission, reoperation and stoma closure rates.
Pouch failure has occurred in 14 patients (7.7%) overall, however there were 12 (11%) in the open group with only 2 (2.6%) in the laparoscopic group, although this is not statistically significant (P = 0.172). No significant difference was seen in pouch dysfunction rates.
Conclusion Laparoscopic restorative proctocolectomy significantly reduces length of stay and minor morbidity and can be offered to an increasing proportion of restorative proctocolectomy patients. A careful collaborative developmental process has occurred in a high volume centre to achieve these results.
Disclosure of Interest I. White: None Declared, J. Jenkins: None Declared, R. Coomber: None Declared, S. Clark: None Declared, R. Phillips: None Declared, R. Kennedy Grant/Research Support from: Ethicon Endosurgery and Olympus UK
Dindo D., Demartines N., Clavien P.A.; Classification of Surgical Complications. Ann Surg. 2004; 244: 931–937.
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