Safety, feasibility, and short-term outcomes in 588 patients undergoing minimally invasive ileal pouch-anal anastomosis: a single-institution experience.

Abstract

A laparoscopic approach to proctocolectomy and ileal pouch-anal anastomosis (IPAA) in patients with chronic ulcerative colitis and familial adenomatous polyposis has grown in popularity secondary to reports of small series demonstrating short-term patient benefits. Limited data exist in large numbers of patients undergoing laparoscopic ileal pouch-anal anastomosis (L-IPAA). We aimed to analyze surgical outcomes in a large cohort of patients undergoing L-IPAA. From a prospectively maintained surgical database, 30-day surgical outcome data were reviewed for all L-IPAA performed for chronic ulcerative colitis and familial adenomatous polyposis from 1999 to 2012. Demographics, operative approach, and operative and postoperative complications were analyzed. A total of 588 L-IPAA ileal pouch-anal anastomoses were performed predominantly for chronic ulcerative colitis (93.9%). The mean age was 36.2years, and 54.3% were male, with a mean BMI of 24.1kg/m(2). Three-stage operations were performed in 17.7%. The mean operating time of the patients excluding 3-stage operation was 269.4min. Minimally invasive techniques included hand-assist in 55% and straight laparoscopy in 45%. Conversion to open occurred in 8.8%. Median length of stay was 5days. There was no mortality. Complications occurred in 36.9% of patients: Clavien grade I (17.5%), grade II (72.8%), and grade III (9.7%). Analysis of the grouped data over time demonstrated a statistically significant reduction in operative time (p<0.001) and an increase in the ratio of hand-assisted over straight laparoscopy (p=0.001). Minimally invasive IPAA performed using either a laparoscopic or hand-assisted technique is safe, can be performed with low conversion rates, and confers beneficial perioperative outcomes.