Laparoscopic versus open proctocolectomy with ileal pouch-anal anastomosis

In recent years laparoscopic proctocolectomy with ileal pouch-anal anastomosis has been used as an alternative to conventional open techniques. Since many published series on proctectomy and ileal pouch-anal anastomosis are based on open experience, in this paper we compare our laparoscopic experience on 21 patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) to 25 patients who had undergone open proctocolectomy with ileal pouch-anal anastomosis. The median operative time in the laparoscopic group was significantly longer than that in the open group (325 min vs. 220 min). However, blood loss was less (115 ml vs.240 ml), bowel function returned earlier (2 days vs.4 days), and hospitalization time was shorter (9 days vs.11 days) in the laparoscopic group (all p<0.05). Early postoperative complications were encountered in five patients of the laparoscopic group and in seven patients of the open group. The median follow-up time was 15 months (range 6-34) in both groups. Late postoperative complications were encountered in three patients of the laparoscopic group and in three patients of the open group. In conclusion, laparoscopic proctocolectomy with ileal pouch-anal anastomosis is technically feasible. The technique described in this study provides the advantages of less blood loss, shorter hospitalization, quicker return of bowel function and more favorable cosmetic results when compared to the open technique.