Laparoscopic versus open 2-stage ileal pouch

Laparoscopic approach allows for faster restoration of intestinal continuity

Alyssa D. Fajardo, Sekhar Dharmarajan, Virgilio George, Steven R. Hunt, Elisa H. Birnbaum, James W. Fleshman, Matthew G. Mutch

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis and familial adenomatous. This study examined the impact of the surgical approach (laparoscopic versus open) to IPAA on short-term outcomes and time to ileostomy closure in 2-stage restorative proctocolectomies. STUDY DESIGN: A retrospective review was performed on a prospectively maintained database at Washington University School of Medicine for patients undergoing elective 2-stage restorative proctocolectomy and IPAA from April of 1999 through July of 2008. Outcomes for patients were analyzed according to laparoscopic versus open technique. RESULTS: A total of 124 patients (55 laparoscopy, 69 open) were included in this study. Laparoscopic IPAA took, on average, 79.2 minutes longer to complete than open IPAA (p < 0.0001) and required significantly more intravenous fluid administration (p = 0.0004). There was no significant difference between laparoscopic and open IPAA with respect to estimated blood loss, blood transfusions, postoperative narcotic usage, return of bowel function, length of stay, and hospital readmission rates. Total complications were not statistically significant between the 2 groups. Patients in the laparoscopic IPAA group underwent ileostomy closure an average of 24.1 days sooner than patients in the open group (p = 0.045). Multivariate analysis revealed that surgical approach (p = 0.018) and length of stay (p = 0.004) were associated with faster time to closure of loop ileostomy. CONCLUSIONS: Laparoscopic IPAA is safe, with postoperative morbidity comparable with open IPAA. Laparoscopic IPAA can lead to faster recovery and result in faster progression to restoration of intestinal continuity in patients undergoing 2-stage restorative proctocolectomy.

Original languageEnglish
Pages (from-to)377-383
Number of pages7
JournalJournal of the American College of Surgeons
Volume211
Issue number3
DOIs
StatePublished - Sep 2010

Fingerprint

Colonic Pouches
Restorative Proctocolectomy
Ileostomy
Length of Stay
Patient Readmission
Postoperative Hemorrhage
Narcotics
Ulcerative Colitis
Blood Transfusion
Intravenous Administration
Laparoscopy
Multivariate Analysis
Medicine
Databases
Morbidity

Keywords

  • familial adenomatous polyposis
  • FAP
  • ileal pouch-anal anastomosis
  • IPAA
  • length of stay
  • LOS
  • UC
  • ulcerative colitis

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic versus open 2-stage ileal pouch : Laparoscopic approach allows for faster restoration of intestinal continuity. / Fajardo, Alyssa D.; Dharmarajan, Sekhar; George, Virgilio; Hunt, Steven R.; Birnbaum, Elisa H.; Fleshman, James W.; Mutch, Matthew G.

In: Journal of the American College of Surgeons, Vol. 211, No. 3, 09.2010, p. 377-383.

Research output: Contribution to journalArticle

Fajardo, Alyssa D. ; Dharmarajan, Sekhar ; George, Virgilio ; Hunt, Steven R. ; Birnbaum, Elisa H. ; Fleshman, James W. ; Mutch, Matthew G. / Laparoscopic versus open 2-stage ileal pouch : Laparoscopic approach allows for faster restoration of intestinal continuity. In: Journal of the American College of Surgeons. 2010 ; Vol. 211, No. 3. pp. 377-383.
@article{d077d478abfa4dd68733eeb8a0b31aa5,
title = "Laparoscopic versus open 2-stage ileal pouch: Laparoscopic approach allows for faster restoration of intestinal continuity",
abstract = "BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis and familial adenomatous. This study examined the impact of the surgical approach (laparoscopic versus open) to IPAA on short-term outcomes and time to ileostomy closure in 2-stage restorative proctocolectomies. STUDY DESIGN: A retrospective review was performed on a prospectively maintained database at Washington University School of Medicine for patients undergoing elective 2-stage restorative proctocolectomy and IPAA from April of 1999 through July of 2008. Outcomes for patients were analyzed according to laparoscopic versus open technique. RESULTS: A total of 124 patients (55 laparoscopy, 69 open) were included in this study. Laparoscopic IPAA took, on average, 79.2 minutes longer to complete than open IPAA (p < 0.0001) and required significantly more intravenous fluid administration (p = 0.0004). There was no significant difference between laparoscopic and open IPAA with respect to estimated blood loss, blood transfusions, postoperative narcotic usage, return of bowel function, length of stay, and hospital readmission rates. Total complications were not statistically significant between the 2 groups. Patients in the laparoscopic IPAA group underwent ileostomy closure an average of 24.1 days sooner than patients in the open group (p = 0.045). Multivariate analysis revealed that surgical approach (p = 0.018) and length of stay (p = 0.004) were associated with faster time to closure of loop ileostomy. CONCLUSIONS: Laparoscopic IPAA is safe, with postoperative morbidity comparable with open IPAA. Laparoscopic IPAA can lead to faster recovery and result in faster progression to restoration of intestinal continuity in patients undergoing 2-stage restorative proctocolectomy.",
keywords = "familial adenomatous polyposis, FAP, ileal pouch-anal anastomosis, IPAA, length of stay, LOS, UC, ulcerative colitis",
author = "Fajardo, {Alyssa D.} and Sekhar Dharmarajan and Virgilio George and Hunt, {Steven R.} and Birnbaum, {Elisa H.} and Fleshman, {James W.} and Mutch, {Matthew G.}",
year = "2010",
month = "9",
doi = "10.1016/j.jamcollsurg.2010.05.018",
language = "English",
volume = "211",
pages = "377--383",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Laparoscopic versus open 2-stage ileal pouch

T2 - Laparoscopic approach allows for faster restoration of intestinal continuity

AU - Fajardo, Alyssa D.

AU - Dharmarajan, Sekhar

AU - George, Virgilio

AU - Hunt, Steven R.

AU - Birnbaum, Elisa H.

AU - Fleshman, James W.

AU - Mutch, Matthew G.

PY - 2010/9

Y1 - 2010/9

N2 - BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis and familial adenomatous. This study examined the impact of the surgical approach (laparoscopic versus open) to IPAA on short-term outcomes and time to ileostomy closure in 2-stage restorative proctocolectomies. STUDY DESIGN: A retrospective review was performed on a prospectively maintained database at Washington University School of Medicine for patients undergoing elective 2-stage restorative proctocolectomy and IPAA from April of 1999 through July of 2008. Outcomes for patients were analyzed according to laparoscopic versus open technique. RESULTS: A total of 124 patients (55 laparoscopy, 69 open) were included in this study. Laparoscopic IPAA took, on average, 79.2 minutes longer to complete than open IPAA (p < 0.0001) and required significantly more intravenous fluid administration (p = 0.0004). There was no significant difference between laparoscopic and open IPAA with respect to estimated blood loss, blood transfusions, postoperative narcotic usage, return of bowel function, length of stay, and hospital readmission rates. Total complications were not statistically significant between the 2 groups. Patients in the laparoscopic IPAA group underwent ileostomy closure an average of 24.1 days sooner than patients in the open group (p = 0.045). Multivariate analysis revealed that surgical approach (p = 0.018) and length of stay (p = 0.004) were associated with faster time to closure of loop ileostomy. CONCLUSIONS: Laparoscopic IPAA is safe, with postoperative morbidity comparable with open IPAA. Laparoscopic IPAA can lead to faster recovery and result in faster progression to restoration of intestinal continuity in patients undergoing 2-stage restorative proctocolectomy.

AB - BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis and familial adenomatous. This study examined the impact of the surgical approach (laparoscopic versus open) to IPAA on short-term outcomes and time to ileostomy closure in 2-stage restorative proctocolectomies. STUDY DESIGN: A retrospective review was performed on a prospectively maintained database at Washington University School of Medicine for patients undergoing elective 2-stage restorative proctocolectomy and IPAA from April of 1999 through July of 2008. Outcomes for patients were analyzed according to laparoscopic versus open technique. RESULTS: A total of 124 patients (55 laparoscopy, 69 open) were included in this study. Laparoscopic IPAA took, on average, 79.2 minutes longer to complete than open IPAA (p < 0.0001) and required significantly more intravenous fluid administration (p = 0.0004). There was no significant difference between laparoscopic and open IPAA with respect to estimated blood loss, blood transfusions, postoperative narcotic usage, return of bowel function, length of stay, and hospital readmission rates. Total complications were not statistically significant between the 2 groups. Patients in the laparoscopic IPAA group underwent ileostomy closure an average of 24.1 days sooner than patients in the open group (p = 0.045). Multivariate analysis revealed that surgical approach (p = 0.018) and length of stay (p = 0.004) were associated with faster time to closure of loop ileostomy. CONCLUSIONS: Laparoscopic IPAA is safe, with postoperative morbidity comparable with open IPAA. Laparoscopic IPAA can lead to faster recovery and result in faster progression to restoration of intestinal continuity in patients undergoing 2-stage restorative proctocolectomy.

KW - familial adenomatous polyposis

KW - FAP

KW - ileal pouch-anal anastomosis

KW - IPAA

KW - length of stay

KW - LOS

KW - UC

KW - ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=77956153086&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77956153086&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2010.05.018

DO - 10.1016/j.jamcollsurg.2010.05.018

M3 - Article

VL - 211

SP - 377

EP - 383

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 3

ER -