Laparoscope-Assisted Versus Conventional Restorative Proctocolectomy with Rectal Mucosectomy

Abstract

To assess the advantages of a laparoscope-assisted proctocolectomy with ileal J-pouch anal anastomosis compared with conventional procedures, we retrospectively analyzed the results of the two procedures as follows: Eleven patients including five patients with familial adenomatous polyposis (FAP) and six with ulcerative colitis (UC) underwent a laparoscope-assisted proctocolectomy and hand-sewn ileal J-pouch anal anastomosis at our department from June 1997 to November 1999. This laparoscope-assisted colectomy (LAC) group was then compared with a group of 13 patients who had undergone conventional ileal pouch anal anastomosis using a standard laparotomy from 1986 to 1997. The median operative time of the LAC group was 8h 23min, which was 81 min longer than that of the standard colectomy (SC) group. The number of days during which eating was prohibited were similar in the two groups but the median postoperative hospital stay was significantly shorter in the LAC group (24.1 days). In the LAC group, the small incisions showed better cosmetic results and there was also a remarkable reduction in the degree of postoperative pain. In conclusion, a laparoscope-assisted proctocolectomy with ileal J-pouch anal anastomosis can be employed widely in patients with FAP and also in selected patients with UC.

Laparoscopic Surgery for Severe Ulcerative Colitis

“…However, with advances in technology and experience of laparoscopic surgery, more favourable results have been stated. Several studies have reported the feasibility and safety of laparoscopic assisted total colectomy for ulcerative colitis in the elective setting, and shown the advantages of laparoscopic assisted total colectomy such as reduced postoperative pain, earlier return of intestinal function, decreased length of hospital stay, and improved cosmesis (Marcello et al, 2000;Hashimoto et al, 2001;Seshadri et al, 2001;Gill et al, 2004;Kienle et al, 2005;Larson et al, 2005). On the basis of these results, several studies have evaluated the feasibility and safety of minimally invasive surgery for selected patients with severe ulcerative colitis (Dunker et al, 2000;Bell & Seymour, 2002;Marceau et al, 2007;Fowkes et al, 2008;Watanabe et al, 2009;Holubar et al, 2009;Chung et al, 2009;Maggiori et al, 2010;Telem et al, 2010).…”

Laparoskopische Chirurgie bei chronisch-entz�ndlichen Darmerkrankungen

“…Gerade beim Morbus Crohn ist in vielen Fällen mit intraabdominellen Abszessen zu rechnen. Bekannte Abszesse von entsprechender Größe und Erreichbarkeit können CToder ultraschallgesteuert drainiert werden und stellen a priori kein Ausschlusskriterium für die laparoskopische Chirurgie dar [16,17] [5,20,21,23]. Aufgrund bisheriger Erfahrungen kann derzeit der Einsatz laparoskopischer Resektionsverfahren in der Therapie der Colitis ulcerosa nicht als Standard empfohlen werden und wird nur in Zentren durchgeführt.…”

“…Insbesondere die erhöhte perioperative Morbidität durch Immunsuppression, Mangelernährung und durch Entzündung hervorgerufene Vulnerabilität des Gewebes lassen minimalinvasive Techniken kritisch erscheinen. Nichtsdestotrotz berichten mehrere Autoren über die sinnvolle Anwendung der Laparoskopie bei Patienten mit CED [1, [3][4][5][6]. …”

Gasless laparoscopic surgery for ulcerative colitis and familial adenomatous polyposis

“…Patients with benign diseases such as ulcerative colitis (UC) and familial adenomatous polyposis (FAP) may be ideal candidates for laparoscopic (procto) colectomy. This procedure remains controversial because of significantly extended operating time compared to that of open procedures [4,6,[9][10][11][12][13], although the difference has come to be minimal with increasing experience in laparoscopic technique [11]. In addition, previous reports revealed that pneumoperitoneum with carbon dioxide, which is commonly used to obtain a good operative field in laparoscopic surgery, is associated with severe cardiopulmonary complications, some of which may be lethal [3,5,8].…”