Totally laparoscopic total proctocolectomy: A safe alternative to open surgery in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) patients have a high incidence of wound and overall postoperative complications. A totally laparoscopic approach could potentially reduce these risks. We adopted totally laparoscopic total proctocolectomy (TL-TPC) using the perineal wound for extraction as the procedure of choice in IBD patients who are not candidates for a restorative procedure. This study looks at the TL-TPC results and compares them with our open cohort. Prospectively collected data from 52 consecutive patients undergoing TL-TPC from 2002 to 2010 were compared to 31 contemporary patients undergoing open TPC. Demographics and patient characteristics including body mass index were similar. Mean operative times were 340 ± 7 minutes for TL-TPC and 337 ± 9 minutes for open TPC (P = 0.91). Intraoperative blood loss was 228 ± 2 mL for TL-TPC and 484 ± 3 mL for open TPC (P < 0.001). Return of bowel function measured as an ileostomy output >100 mL per 8 hours occurred at 2.7 ± 2.8 days for TL-TPC versus 3.3 ± 1.8 days for open TPC (P = 0.025). The length of stay was 8.4 ± 5.0 days for TL-TPC versus 9.2 ± 3.2 days for open TPC (P = 0.05). The overall complication rate was 43% for TL-TPC versus 65% for open TPC (P = 0.07). Postoperative abdominal wound infections and parastomal hernias occurred in 23% and 10% of open TPC patients, respectively, versus zero (P = 0.001) and 6% (P = 0.67) for TL-TPC. TL-TPC is therefore considered a safe alternative to open surgery for selected IBD patients not candidates for a restorative procedure.