Erman Aytac, Ozgen Isik, Feza H Remzi, James M Church, Hermann Kessler. Derpartment of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, OH
INTRODUCTION: Restorative proctocolectomy (RP) with ileal pouch-anal anastomosis (IPAA) is the operation of choice for patients with familial adenomatous polyposis (FAP) and a profuse colorectal phenotype. Laparoscopic techniques have potential advantages for young patients undergoing colectomy and have been applied to this surgery. However, data confirming these potential benefits are limited. In this study, we aim to compare the short-term outcomes of open versus laparoscopic RP in patients with colonic polyposis by using a large, nationwide surgical database.
METHODS AND PROCEDURES: Since there are no specific ICD codes for familial polyposis syndromes in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, patients who underwent RP/IPAA (CPT codes: 44158,44211) and had been coded as colonic polyposis (ICD-9:211.3) between 2005-2012 were included. Demographics, peri-operative and short-term surgical outcomes were compared between the open and laparoscopic groups.Continuous data are presented as median (interquartile range) and categorical data as percentage.
RESULTS: 135 patients had laparoscopic and 106 patients had open RP.The groups were similar in demographic,medical and lifestyle factors,with similar age [30 (22-41)vs.32(24-46),p=0.26],male gender(49.6vs.61.3%,p=0.07),BMI [27(23-31)vs.28(23-33,p=0.43],andASA(I-II)score(78.5vs.76.4%,p=0.70). Diabetes was more frequent with patients undergoing open surgery (2.2vs.10.4%,p=0.01). The probability of mortality[0.0007(0.0004-0.0016) vs. 0.0008(0.0005-0.0018),p=0.14] was comparable between the groups, but the probability of morbidity was higher in open cases [0.15 (0.11-0.19) vs. 0.18 (0.15-0.25),p<.0001],possibly because of the increased incidence of diabetes. Operating time[307(249-393)vs.242(194-319),p<.0001] was longer in the laparoscopic group. Requirement of transfusion (2vs.5 %,p=0.31),length of stay [6(5-9)vs.7(5-9),p=0.07] and postoperative complication rates were comparable between the groups (table).
CONCLUSIONS: Historical data show that laparoscopic RP offers smaller incisions and less pain to patients with FAP. In this study, the nationwide data demonstrated this can be achieved without an increase in postoperative morbidity.
|Deep incisional SSI||3.7||3.8||0.98|
|Organ space SSI||5.2||8.5||0.31|
|Progressive renal insufficiency||0||1.9||0.19|
|Acute renal failure||0||0.9||0.44|
|DVT requiring therapy||1.5||0.9||>0.99|
|Return to operating room||7.4||3.8||0.23|