Laparoscopic Vs. Open Proctocolectomy in the Treatment of Ulcerative Colitis and Familial Adenomatous Polyposis

Introduction: Restorative proctocolectomy is the operation of choice for patients with ulcerative colitis (UC) and familial polyposis coli (FAP). The role of laparoscopy for this extended procedure has been controversial given its technical difficulty, high conversion rate, and complications. But recent reports have demonstrated that these laparoscopically extensive colorectal resections are feasible and safe. The aim was to compare our results of lap and open proctocolectomy for UC or FAP in a single centre study. Methods: A retrospective review of all patients who underwent a proctocolectomy at our department from Jan-00 to Jun-08. Demographic, intraop and postop data were compared. Results: 50 patients underwent proctocolectomy. Of these, 11 patients were excluded because they were operated at the Emergency Dept. In the remaining group of 39 patients, 15 were operated by lapy (LP) and 24 t open surgery (OP).Patient age, gender and the procedures performed (proctocolectomy + J pouch ileoanal anastomosis or proctocolectomy + end ileostomy) were equally divided in both groups. UC vs. FAP distribution was 27% vs. 63% in the LP group, compared to 54% vs. 46% in the OP group (ns). Median op. time was significantly longer for the lap group (283 min vs. 222 min, p=.001). One lap case was converted (7%). Both groups had a similar postop recovery: return of bowel movement 2.6 d. (LP) vs. 2.5 (OP) d., return to oral diet 4.4 d. (LP) vs. 4.3 d. (OP), length of hospital stay 15 days (LP) vs. 13 days (OP). Postop. morbidity was equal between LP and OP: anastomotic leakage 15% vs. 11%, pelvic abscesses 13% vs. 17%, pelvic hematoma 7 % vs. 4%. We observed significant fewer complications after ileostomy closure in the lap group: 13% vs. 31%. (p=.01) Conclusion: Laparoscopic proctocolectomy are equivalent to open proctocolectomy in terms of feasibility, safety and postop recovery. Although median operative time was longer in the LP group, we observed fewer complications after ileostomy closure.

Session: Poster

Program Number: P126