The results of laparoscopic total colectomy with ileal J-pouch anal anastomosis for ulcerative colitis

Tomoya Abe, Takeshi Naito, Munenori Nagao, Kazuhiro Watanabe, Hiroaki Musha, Shinobu Onuma, Naoki Tanaka, Katsuyoshi Kudo, Hideaki Karasawa, Takanori Morikawa, Kei Nakagawa, Takaho Okada, Hiroki Hayashi, Hiroshi Yoshida, Fuyuhiko Motoi, Yu Katayose, Michiaki Unno. Tohoku university hospital

[Background] Nowadays, ulcerative colitis (UC) is the basically treated by conservative medication therapy which is represented by anti-inflammatory drugs, or by immunological treatment such as anti-TNF alpha agents. However, it often requires surgical intervention when the medical treatment is failed or other emergent complications occur. Since UC is the young onset disease and its incidence is higher in women, the minimally invasive surgery would have great impact on their QOL. We have been, therefore, performing a laparoscopic total colectomy (LTC) with ileal J-pouch anal anastomosis (IAA) for UC since 2001. In the early days, procedures were mostly performed by a hand-assisted laparoscopic approach, and then we turned to adopt the laparoscopic approach for elective surgery cases. In this study, we verify the efficacy of LTC compared to open or hand-assisted approach.

[Patients & Methods] UC patients who underwent total colectomy with IAA from 2001 through 2013 in our institute were included in this study. Of those patients, operative outcomes and morbidity were assessed retrospectively.

[Results] A total of 58 patients were included; an open total colectomy (OTC) was performed on 18 patients, a hand-assisted laparoscopic surgery (HALS) on 31 and a laparoscopic procedure on 9. Among these cases, a mean age of patients are highest in the OTC group (OTC, HALS and LTC: 51.9±14.0, 35.3±12.4 and 35.6±16.7 year-old), and a duration of operation was also shortest in the OTC group (409±91, 472±94 and 505±100 min, respectively). Estimated blood loss was seemed lower in LTS group, though it was not statistically significant. The incidence of postoperative intestinal obstruction was significantly higher in the LTC group (OTC, HALS and LTC: 5.6%, 19.4% and 55.6%). Main cause of the intestinal obstruction was twisting and bending of the ileum around loop ileostomy. It might be due to the feature of less adhesion in a laparoscopic surgery. It was treated by stenting Foley catheter into the ileum from the ileostomy avoiding reoperation. There were no significant differences regarding other complication incidences or a length of postoperative hospital stay among groups.

[Conclusion] Although the incidence of postoperative intestinal obstruction was high, the laparoscopic total colectomy with IAA seems effective and would be beneficial for patients’ QOL.

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