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

• Published in: Inflammatory bowel diseases Vol. 18; no. 5; pp. 863 - 868
• Main Authors: Holder‐Murray, Jennifer, Zoccali, Marco, Hurst, Roger D., Umanskiy, Konstantin, Rubin, Michele, Fichera, Alessandro
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.05.2012
• Subjects: Colectomy; Colitis, Ulcerative - surgery; Crohn Disease - surgery; Crohn's disease; Female; Follow-Up Studies; Humans; inflammatory bowel disease; Intestinal Perforation; laparoscopic; Laparoscopy; Male; Middle Aged; Proctocolectomy; Proctocolectomy, Restorative; Prognosis; Prospective Studies; Retrospective Studies; Risk Factors; ulcerative colitis
• DOI: 10.1002/ibd.21808
• ISSN: 1078-0998

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. (Inflamm Bowel Dis 2011;)