Early Experience with Laparoscopic Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

Abstract

The purpose of this study was to describe our minimally invasive technique and outline perioperative and medium-term outcomes in patients undergoing laparoscopic ileal pouch-anal anastomosis (LIPAA) for ulcerative colitis. Data were obtained from a prospectively collected database of 13 LIPPA procedures performed for ulcerative colitis between May 1994 and November 2000. Medium-term quality-of-life follow-up was obtained by telephone interview. Eight males and five females had an LIPAA performed, all of whom had previously undergone total abdominal colectomy with ileostomy. Median operative time was 255 minutes (range, 200-398 minutes) with one conversion (8%) due to adhesions. There were no deaths or intraoperative complications; however, six patients experienced seven postoperative complications within 30 days of final closure of defunctioning ileostomy (two leaks, two wound infections, one pulmonary embolus, and two reoperations for small bowel obstruction). Median length of stay was 7 days (range, 5-13 days). Median follow-up was 24 months (range, 6-66 months). The median number of day and night bowel movements was 6.0 (range, 3-10) and 1.0 (range, 0-3), respectively, with five patients requiring medication to control frequency. None had incontinence of stool or retrograde ejaculation; however, one had occasional incontinence of gas, three had occasional nocturnal soiling, and one was impotent. Three patients (23%) had pouchitis, all treated successfully with oral antibiotics. All patients were satisfied with the outcome of their operation and all preferred their pouch to previous ileostomy. Patients reported their overall social, emotional, and physical well being to be satisfactory to excellent. Results of the SF-36, a generic quality-of-life survey, were similar to those from studies of patients following an open pelvic pouch procedure. The LIPAA is technically feasible in experienced centers. We believe that the technique is still evolving and that more time and experience is required to refine the procedure.

Total laparoscopic ileal pouch-anal anastomosis: prospective series of 82 patients

“…However, despite development of laparoscopy in colorectal surgery, very few studies to date have reported large experience of laparoscopic IPAA, mainly because IPAA is considered a major surgical procedure. To our knowledge, in the majority of these studies, fewer than 35 patients were included in each [6,[13][14][15][16][17][18][19][20][21]. Furthermore, because of the complexity of the procedure, in these studies IPAA was mainly performed under either laparoscopy-assisted technique or with a handassisted device and not by total laparoscopic approach.…”

“…To date, few studies have been devoted to the role of laparoscopy in IPAA and most of them have included patients operated by hand-assisted [6,13] or laparoscopicassisted technique [14][15][16][17][18][19][20][21]. Furthermore, all these series have included fewer than 40 patients.…”

Total laparoscopic proctocolectomy with Brooke ileostomy: a novel incisionless surgical treatment for patients with ulcerative colitis

“…The reported benefits include improved cosmesis, reduced pain, earlier return of bowel function, decreased morbidity, decreased hospital stay, improved nutrition, preservation of immune response, and decreased short-and long-term complications. Moreover, functional outcomes and quality-of-life measurements also are comparable between open and laparoscopic techniques [1,2,9].…”

Laparoscopic-assisted proctocolectomy using complete intracorporeal dissection

“…Many groups have demonstrated good results using a laparoscopic approach for proctocolectomies; however most of them make additional incisions, either medial or Pfannenstiel, to dissect the rectum or to resect the specimen [2][3][4][5][6][7][8][9][10].…”