Shintaro Ishikawa, S Yamaguchi, T Ishii, H Kondo, M Suzuki, K Hara, H Shimizu, K Takemoto, T Okada, S Sakuramoto, K Okamoto, I Koyama. Saitama Medical University International Medical Center, Japan
Background: Laparoscopic total proctocolectomy (TPC) is selected for minimally invasive surgical treatment of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). Our policy of TPC is no diverting ileostomy for FAP and creating ileostomy for IBD because most of the patients received steroid therapy.
Objective: We examined the outcome of laparoscopic TPC according to disease of FAP and IBD (UC and Crohn's disease).
Methods: Twenty-three consecutive patients who underwent laparoscopic TPC between April 2007 and March 2017 were examined. The patients were divided into FAP group and IBD group.
Results: Seven patients of FAP and 16 patients of IBD (UC 15, Crohn's disease 1) underwent laparoscopic TPC or total colectomy. Among them, 12 patients (FAP 3, IBD 9) were cancer-associated cases. The procedures of the FAP group was TPC with IACA in 6 patients and HALS total colectomy with IRA in 1 patient. The procedures of IBD group were TPC with IACA in 11 patients, TPC with IAA in 2 patients, total colectomy with IRA in 3 patients, of which 5 HALS cases. The mean operative time and blood loss were 318 minutes, 32.0g in the FAP group and 382 minutes, 86.8g in the IBD group, respectively. Diverting ileostomy was constructed in 11 patients of only UC group. Early complications of FAP group were observed in 3 cases (postoperative ileus 2, anastomotic leak with conservative treatment 1), and those of IBD were observed in 8 cases (ileus 4, anastomotic leak with conservative treatment 1, abdominal abscess 1, wound infection 1). The median postoperative hospital stay was 12 days in the FAP group and 14 days in the IBD group. Complications requiring reoperation were 2 cases (FAP 1: intestinal obstruction, IBD 1: inflammation of stoma-closure site). No cancer recurrence and mortality were observed. One case of FAP underwent additional transanal mucosal resection due to new lesion of adenoma.
Conclusions: Laparoscopic total proctocolectomy for FAP and IBD was performed safely, especially less complications occurred in FAP patients without diverting ileostomy. In addition, follow-up of remaining mucosa is important in IACA and IRA patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87512
Program Number: P282
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster