Intervention Review

Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis

  1. Usama Ahmed Ali1,*,
  2. Frederik Keus2,
  3. Joost T Heikens3,
  4. Willem A Bemelman4,
  5. Stephane V Berdah5,
  6. H G Gooszen6,
  7. Cees JHM van Laarhoven7

Editorial Group: Cochrane Colorectal Cancer Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 3 NOV 2008

DOI: 10.1002/14651858.CD006267.pub2

Database Title

Additional Information

How to Cite

Ahmed Ali U, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, van Laarhoven CJHM. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD006267. DOI: 10.1002/14651858.CD006267.pub2.

Author Information

  1. 1

    Dutch Pancreatitis Study Group, University Medical Center Utrecht, Department of Surgery, Utrecht, Utrecht, Netherlands

  2. 2

    Diakonessenhuis, Surgery, Utrecht, Utrecht, Netherlands

  3. 3

    St Elisabeth Hospital, Surgery, Tilburg, Netherlands

  4. 4

    Academic Medical Centre, Amsterdam, Department of Surgery, Amsterdam, Netherlands

  5. 5

    Höpital Nord - Marseille, Department of Digestive Surgery, Marseille, Cedex 20, France

  6. 6

    University Medical Center, Surgery, Utrecht, Utrecht, Netherlands

  7. 7

    University Medical Centre Nijmegen, Department of Surgery 690, HB Nijmegen, Netherlands

*Usama Ahmed Ali, Department of Surgery, Dutch Pancreatitis Study Group, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht, Utrecht, 3508 GA, Netherlands. U.ahmedali@gmail.com. u.ahmedali@umcutrecht.nl.

Publication History

  1. Publication Status: New
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Restorative proctocolectomy with ileo pouch anal anastomosis (IPAA) is the main surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). With the advancements of minimal-invasive surgery this demanding operation is increasingly being performed laparoscopically. Therefore, the presumed benefits of the laparoscopic approach need to be systematically evaluated.

Objectives

To compare the beneficial and harmful effects of laparoscopic versus open IPAA for patients with UC and FAP.

Search methods

We searched The Cochrane IBD/FBD Group Specialized Trial Register (April 2007), The Cochrane Library (Issue 1, 2007), MEDLINE (1990 to April 2007), EMBASE (1990 to April 2007), ISI Web of Knowledge (1990 to April 2007) and the web casts of the American Society of Colon and Rectal Surgeons (ASCRS) (up to 2006) for all trials comparing open versus laparoscopic IPAA.

Selection criteria

All trials in patients with UC or FAP comparing any kind of laparoscopic IPAA versus open IPAA. No language limitations were applied.

Data collection and analysis

Two authors independently performed selection of trials and data extraction. The methodological quality of all included trials was evaluated to assess bias risk. Analysis of RCTs and non-RCTs was performed separately. Analyses were based on the intention-to-treat principle. Authors were requested additional information in case of missing data. Sensitivity and subgroup analyses were performed if appropriate.

Main results

Eleven trials included 607 patients of whom 253 (41%) in the laparoscopic IPAA group. Only one of the included trials was a randomised controlled trial. There were no significant differences in mortality or complications between the two groups. Reoperation and readmission rates were not significantly different. Operative time was significantly longer in the laparoscopic group both in the RCT and meta-analysis of non-RCTs (weighted mean difference (WMD) 91 minutes; 95% Confidence Interval (CI) 53 to 130). There were no significant differences between the two groups regarding postoperative recovery parameters. Total incision length was significantly shorter in the laparoscopic group, while two trials evaluating cosmesis found significantly higher cosmesis scores in the laparoscopic group. Other long-term outcomes were poorly reported.

Authors' conclusions

The laparoscopic IPAA is a feasible and safe procedure. Short-term advantages of the laparoscopic approach seem to be limited and their clinical significance is arguable. Large high-quality trials focusing on differences regarding specific postoperative complications, cosmesis, quality of life and costs are needed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Open versus laparoscopic approach to pouch surgery in patients with ulcerative colitis and familial adenomatous polyposis showed no significant differences in mortality and complications, but the laparoscopic approach resulted in better cosmesis.

Resection of the entire colon and creation of an ileal pouch by means of an ileo pouch anal anastomosis (IPAA) is a last resort for many patients with ulcerative colitis and familial adenomatous polyposis. In recent years this operation has increasingly being performed laparoscopically. In this review we compared the open versus laparoscopic IPAA. We found no significant differences in mortality and complications between the two techniques. The laparoscopic IPAA had a longer operative time of on average 90 minutes. No reliable conclusions could be made regarding the benefit of laparoscopic IPAA on the postoperative recovery. Findings suggest that the laparoscopic approach may improve the postoperative recovery, but the importance of these advantages seems limited. The laparoscopic IPAA did result in better cosmesis than the open IPAA, but more studies will be needed to confirm these findings.
The most important limitation of this review is that we only found one randomised controlled trial (RCT) on this subject, and we therefore needed to include non-randomised controlled trials. Another important limitation is that most studies did not report on important long-term outcomes, like quality of life and functional outcome.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

開放性剖腹與腹腔鏡(輔助)迴腸袋肛管吻合術治療潰瘍性結腸炎和家族性大腸瘜肉症

大腸直腸切除術加迴腸成袋與肛門吻合術Restorative proctocolectomy with ileo pouch anal anastomosis(IPAA)是潰瘍性結腸炎(UC)和家族性大腸瘜肉症(FAP)的主要外科治療.隨著微創手術的進步,進行腹腔鏡操作需求越多.因此推定腹腔鏡的好處須要系統性的評估.

目標

比較潰瘍性結腸炎(UC)和家族性大腸瘜肉症(FAP)患者接受腹腔鏡與開放性剖腹迴腸袋肛管吻合術的好處與壞處.

搜尋策略

我們搜尋了Cochrane IBD/FBD Group Specialized Trial Register (April 2007), The Cochrane Library (Issue 1, 2007), MEDLINE (1990 to April 2007), EMBASE (1990 to April 2007), ISI Web of Knowledge (1990 to April 2007) and the web casts of the American Society of Colon and Rectal Surgeons (ASCRS) (up to 2006)所有比較腹腔鏡與開放性剖腹迴腸袋肛管吻合術的試驗.

選擇標準

所有試驗比較潰瘍性結腸炎(UC)或家族性大腸瘜肉症(FAP)患者,接受腹腔鏡迴腸袋肛管吻合術與與開放性剖腹迴腸袋肛管吻合術.應用上沒有語言限制.

資料收集與分析

兩位作者獨立進行審判和選擇提取數據,試驗包括使用質量的方法去評估,評價偏見.隨機對照試驗的分析和非隨機對照試驗是分開進行.分析是根據意向性治療原則,個案遺失資料,作者被要求提供補充資料敏感性和亞組分析適當的進行.

主要結論

11組試驗包括607個患者其中 253 (41%)是腹腔鏡迴腸袋肛管吻合術組.包括只有一個試驗是隨機對照試驗.在兩組之間死亡率和併發症沒有顯著差異.再手術和再入院率沒有顯著差異.腹腔鏡組明顯的手術時間比較長,無論是在隨機對照試驗和整合分析的非隨機對照試驗.(加權均數差(WMD)91分鐘，95％置信區間(CI)的53至130).術後恢復方面的參數,兩組之間沒有明顯的差異.腹腔鏡組總切口長度明顯較短,兩個試驗評估美觀,發現內視鏡組明顯的美觀分數較高.其他長期結果報告不足.

作者結論

腹腔鏡迴腸袋肛管吻合術是一種可行和安全的程序.腹腔鏡方法的短期優勢似乎是有限的,臨床意義也值得商確.更須要大型高品質的試驗區別集中在有關具體術後併發症,美觀，生活品質和成本.

翻譯人

本摘要由國泰綜合醫院張世昌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

潰瘍性結腸炎和家族性大腸瘜肉症的開放性剖腹與內視鏡迴腸袋肛管吻合術比較顯示在死亡率和合併症上沒有顯著差異,但是腹腔鏡迴腸袋肛管吻合術有比較好的美觀.全結腸切除和創造一個有迴腸袋的方式,迴腸袋肛管吻合術(IPAA),是很多潰瘍性結腸炎和家族性腺瘤性息肉患者治療的最後手段.最近幾年這個手術用腹腔鏡來做越來越多,在這個審查中我們比較開放性剖腹與腹腔鏡迴腸袋肛管吻合術.我們發現兩者間在死亡率和合併症上沒有顯著的差異.腹腔鏡迴腸袋肛管吻合術手術時間較長,平均90分鐘.在腹腔鏡迴腸袋肛管吻合術的術後恢復上,沒有可靠的結論能說他的好處提升,但這些優勢的重要性似乎有限.腹腔鏡迴腸袋肛管吻合術比開放式迴腸袋肛管吻合術帶來更好的美觀結果.但將需要更多的研究確認這些結果.本次審查的最重要的限制是在這個問題上我們只找到一個隨機對照試驗(RCT),因此，我們需要包括非隨機對照試驗.另外一個重要的限制是大多數研究沒有報告重要的長期結果,像是生活品質和功能性結果.

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