Laparoscopic restorative proctocolectomy and ileal pouch anal anastomosis for familial adenomatous polyposis is safe in short-term outcomes compare with open surgery

Kiyoshi Tsukamoto, MD, PhD, Nagahide Matsubara, MdD, PhD, Masashi Takemura, MD, PhD, Masafumi Noda, MdD, PhD, Tomoki Yamano, MD, PhD, Naohito Beppu, MD, Mie Yoshimura, MD, Masayoshi Kobayashi, MD, Michiko Hamanaka, MD, Naohiro Tomita, MD, PhD. Department of Surgery, Hyogo College of Medicine

INTRODUCTION- The aim of this study was to compare the short-term outcomes of laparoscopic (Lap) and open restorative proctocolectomy and ileal pouch anal anastomosis (IPAA) for patients with familial adenomatous polyposis (FAP) in a single institute in Japan. IPAA is now standard operation for patients with FAP. Herein we report the short-term outcomes of Lap vs. open IPAA for FAP and some noteworthy points of Lap IPAA.

METHODS AND PROCEDURE- Retrospectively collected data from 72 patients who underwent IPAA for FAP at Hyogo College of Medicine from 2000-2014 was analysed. Short-term outcomes of patients who underwent Lap (n=14) and open (n=48) procedures are compared.

RESULTS- Mean operation time was significantly longer in Lap compared with open (436 and 247mins p<0.001). Mean hospital stay was significantly shorter in Lap compared to open (21 and 27days respectively p<0.01). There was no significant difference either in blood loss (220 and 180ml p=0.09), anastomotic leakage (3/14 and 1/48 p=0.05), rate of one-staged operation (64.3 and 81.3 % p=0.33) or post-operative bowel obstruction (1/14 and 3/48 p=0.62) between the two groups (all data are Lap and open). Although, there are no significant differences, Lap procedure tends to increase anastomotic leakage and decrease the rate of one-staged operation. In Lap procedure, it is rather difficult to confirm ileal pouch long enough to come down to anal verge. And also it is not easy to lead ileal pouch down to anal via pelvic cavity. As a consequence of our early experience of Lap procedure, where unplanned two-staged operation was required in one patient due to peritoneal faecal soiling originating from the anal stump after removal of the resected colon and rectum from abdominal cavity, after this experience, we have modified our surgical procedure.

CONCLUSIONS- In conclusion, Lap IPAA can be performed safely in patients with FAP. Shorter postoperative stay and superior cosmetic results further support the adoption of Lap approach. However, there are some different aspects to be careful compared with open surgery. We present some noteworthy points of Lap IPAA for patients with FAP.

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