Totally laparoscopic total proctocolectomy: A safe alternative to open surgery in inflammatory bowel disease
Article first published online: 14 JUL 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 5, pages 863–868, May 2012
How to Cite
Holder-Murray, J., Zoccali, M., Hurst, R. D., Umanskiy, K., Rubin, M. and Fichera, A. (2012), Totally laparoscopic total proctocolectomy: A safe alternative to open surgery in inflammatory bowel disease. Inflamm Bowel Dis, 18: 863–868. doi: 10.1002/ibd.21808
- Issue published online: 12 APR 2012
- Article first published online: 14 JUL 2011
- Manuscript Accepted: 26 MAY 2011
- Manuscript Received: 19 MAR 2011
- ulcerative colitis;
- Crohn's disease;
- inflammatory bowel disease
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.
Prospectively collected data from 52 consecutive patients undergoing TL-TPC from 2002 to 2010 were compared to 31 contemporary patients undergoing open TPC.
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.
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;)