Sherazuddin Qureshi, MD, MA, Brittany Potz, MD, MA, Meridith Chan, BA, Ashar Ata, MBBS, MPH, Brian T Valerian, MD, Edward C Lee, MD
Department of Surgery, Albany Medical College
INTRODUCTION – Our aim is to review our experience and determine any differences in outcomes between ileorectal anastomoses and ileocolic and colorectal anastomosis by comparing single-stage laparoscopic total abdominal colectomies to right and sigmoid colectomies.
METHODS AND PROCEDURES – Our institutional database from 2002 to 2012 was queried to identify electively performed single-stage laparoscopic colectomies for the following diagnoses: colonic inertia, neoplasm, inflammatory bowel disease, and prior history of diverticulitis. The age, gender, and BMI was retrospectively collected for total colectomies via chart review. These were then case matched to similar patients (for age, gender, and BMI) that underwent elective single-stage laparoscopic right hemicolectomies and sigmoid colectomies. The following additional data was then retrospectively collected for all three groups: prior surgical history, American Society of Anesthesiologists (ASA) level, estimated blood loss (EBL), length of procedure, return of bowel function, time to tolerance of oral intake, length of stay, and incidence of postoperative ileus or anastomotic leak. Cases where data was incomplete were excluded. Outcomes of interest included length of stay (days), return of bowel function measured by time to flatus (days), time to tolerance of oral diet (days), and postoperative complications. Independent samples t-tests were implemented to compare these groups and determine any significant difference in these endpoints.
RESULTS – Three groups of 30 patients each that were similarly matched to age, gender, and BMI were analyzed. History of prior surgery was not significant between the total colectomy and right and sigmoid colectomy group (p=0.23 and p=0.07). Right hemicolectomies lost significantly less blood intraoperatively (31 mL) when compared to total colectomies (114 mL), (p=0.01) versus sigmoid colectomies (61 mL), (p=0.15). Total colectomies had a longer operative time (146 minutes) versus both right hemicolectomies (92 minutes) and sigmoid colectomies (110 minutes), (p<0.001). Return of bowel function was not significantly different between total colectomies (5 days) versus right hemicolectomies (4 days) or sigmoid colectomies (4 days), (p=0.18 and p=0.12), respectively. Total colectomies, however, took longer to tolerate a diet (8 days) versus right hemicolectomies (5 days) and sigmoid colectomies (5 days), (p=0.03 and 0.01). Lastly, total colectomies had a significantly higher incidence of ileus and anastomotic leak compared to right hemicolectomies and sigmoid colectomies (p<0.001).
CONCLUSIONS – Elective, single-stage laparoscopic total abdominal colectomies with an ileorectal anastomosis for IBD, colonic inertia, or colonic neoplasms have a delayed tolerance of diet, more incidence of ileus and anastomotic leak and a longer length of stay when compared with similarly matched patients undergoing single-stage laparoscopic right hemicolectomies and sigmoid colectomies. Further investigation is needed to elucidate what unrecognized factors may be contributing to poorer outcomes in this subset.
Session: Poster Presentation
Program Number: P028
