Feasibility of laparoscopic restorative proctocolectomy without diverting stoma

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• 作者：Thé ; vy Hor¹ ; Sté ; phane Zalinski¹ ; Jé ; ré ; mie H. Lefevre ; Conor Shields ; Emmanuel Attal ; Emmanuel Tiret ; Yann Parc ; ^{yann.parc@sat.aphp.fr}
• 关键词：Ileostomy ; Ileal pouch anal anastomosis ; Laparoscopic restorative proctocolectomy
• 刊名：Digestive and Liver Disease
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：44
• 期：2
• 页码：118-122
• 全文大小：173 K

文摘

Aim

Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy.

Method

Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database.

Results

Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n = 34), ulcerative colitis (n = 35), indeterminate colitis (n = 1) and Lynch syndrome (n = 1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29 % (n = 4/14) and 21 % (n = 12/21) in patients with and without a stoma (p = 0.8), and the rate of fistula was 21 % and 5 % , respectively (p = 0.08). Seven percent of patients with a stoma and 16 % without stoma had an intra-abdominal collection (p = 0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma.

Conclusion

Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.