Laparoscopic restorative proctocolectomy: a 10-year experience of an evolving technique

Restorative proctocolectomy is the definitive procedure for ulcerative colitis. The potential benefits of a minimal invasive approach make it appropriate to consider this approach provided that there are no adverse effects. The aim of the present study was to report our experience of laparoscopic assisted and 'total' laparoscopic restorative proctocolectomy (LRPC) and to highlight the difficulties encountered and the functional results obtained.

Electronic data were prospectively collected from all patients who underwent laparoscopic restorative proctocolectomy (LRPC) from October 1999 to April 2010.

Seventy-two (40 male) patients [median body mass index 24 (19-48) kg/m(2) ] underwent LRPC over 10 years. Three had cancer. Forty-two had undergone a previous colectomy (laparoscopic in 38). There were 40 W- and 32 J-pouch reconstructions; seven were single-port procedures. The median operation time was 210 (75-330) min. There were five (7%) conversions, one of which resulted in immediate pouch failure. The median time to full diet was 36 (4-168) h, with a median hospital stay of 7 (2-64) days. There were seven (10%) readmissions. Complications were immediate (3%), early (22%) and long term (11%). The incidence of failure (excision or indefinite diversion) was 2.7%. The stoma has been closed in 67 patients. Median frequency of defaecation was 4/24 h, with normal continence in 90% and the ability to defer during the day in 98%. There was no new case of impotence or dyspareunia.

Laparoscopic restorative proctocolectomy is safe and gives good results when performed by an experienced laparoscopic surgeon.