Outcomes of a laparoscopic approach for total abdominal colectomy and proctocolectomy

The role of laparoscopy for total abdominal colectomy (TAC) and total proctocolectomy (TPC) has been controversial given its technical difficulty, high conversion rate, and complication rate. Recent studies have documented its efficacy for experienced laparoscopic surgeons. The outcomes of a prospective series of patients undergoing TAC and TPC are presented.

A consecutive series of patients undergoing TAC or TPC were identified from prospectively collected data during 2002 to 2005. The database reflects a single colon and rectal surgical specialty practice. Patient characteristics, surgical parameters, and patient outcomes were documented.

From a total of 51 patients, 19 underwent TAC and 32 underwent TPC. There were 26 women and 35 men. The mean patient age was 40 years (range, 17-74 y). The mean body mass index was 25 (range, 19-38). Twelve patients underwent surgery for colonic inertia, 2 for familial adenomatous polyposis, and 37 for chronic ulcerative colitis. Of the ulcerative colitis patients, 8 patients had toxic colitis, 4 had dysplasia, and 25 had medically refractory disease. The overall mean surgical time was 163 minutes (range, 85-227 min): the mean surgical time for TAC was 131 minutes (range, 85-189 min) and for TPC was 197 minutes (range, 131-227 min). The overall mean blood loss was 200 mL (range, 75-500 mL). The mean length of stay was 4.8 days (range, 2-16 d). Open conversion was required in 5 patients: 3 with toxic colitis (38%), and 2 during elective colectomy (4.8%). Ten complications occurred (19.7%) with no mortality.

A laparoscopic approach to TAC and TPC is efficacious and safe. It is a viable alternative to open surgery for surgeons experienced with the laparoscopic approach to colectomy. Patients with toxic colitis may undergo a laparoscopic approach but will have a higher open conversion rate.