Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis.

ABSTRACT

PURPOSE: Randomized controlled trials (RCTs) demonstrated that a laparoscopic approach provides short-term benefits, such as reduced blood loss and a shorter hospital stay, in patients who undergo rectal surgery. On the other hand, a few RCTs investigating proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) suggested limited advantages of laparoscopic surgery over open surgery. A substantial proportion of patients with UC or FAP may undergo staged operations with IPAA, but no study has compared the two approaches for proctectomy with IPAA after total abdominal colectomy. METHODS: We examined 61 consecutive patients with UC or FAP who underwent proctectomy with IPAA after colectomy in our hospital. Patients were divided into the Lap group (n = 37) or the Op group (n = 24) according to surgical approach. Patient background and outcomes, such as operative time, blood loss, first bowel movement, postoperative complications, and pouchitis, were compared between these groups. RESULTS: One patient required conversion to open surgery in the Lap group. The median volume of blood loss was 90 mL in the Lap group and 580 mL in the Op group (p < 0.0001). The Lap group showed a shorter time to first bowel movement than the Op group (median 1 vs 2 days, p = 0.0003). The operative time, frequencies of postoperative complications, and accumulation rate of pouchitis were similar between the two groups. CONCLUSIONS: Laparoscopic surgery was beneficial for patients undergoing restorative proctectomy in terms of blood loss and bowel recovery without increasing the operative time or rate of complications.