Comparison of Three Minimally Invasive Surgical Approaches for Restorative Proctocolectomy in Ulcerative Colitis: A...

Restorative proctocolectomy (RPC) is the most frequently performed procedure for patients with ulcerative colitis (UC) requiring surgical intervention. Although several approaches to laparoscopic RPC for UC have been documented, the optimal minimally invasive surgical (MIS) approach remains to be firmly established. This study aims to compare the postoperative complication rates and surgical outcomes of three MIS approaches for RPC: laparoscopic surgery (Lap), hand-assisted laparoscopic surgery (HALS), and reduced port surgery combined with taTME (RPS + taTME).

This retrospective study included 156 patients who underwent two-stage RPC for UC via laparoscopy at Keio University Hospital between February 2002 and February 2022. The influence of patient characteristics on postoperative complications and surgical outcomes was evaluated using Fisher's exact test, analysis of variance (ANOVA), or logistic regression analysis.

Of the 156 patients, 60 underwent Lap, 46 underwent HALS, and 50 underwent RPS + taTME. Postoperative complication rates were 43.3% for Lap, 50.0% for HALS, and 36.0% for RPS + taTME. There were no significant differences in postoperative complications between the surgical approaches (HALS vs. Lap: odds ratio (OR) 0.54, 95% confidence interval (CI) 0.18-1.69, p = 0.29; RPS + taTME versus Lap: OR 1.57, 95% CI 0.63-3.89, p = 0.33). Operative time was significantly shorter in the HALS group, while estimated blood loss was significantly lower in the RPS + taTME group.

This study highlights the distinct characteristics of three MIS approaches for laparoscopic RPC. The incidence of postoperative complications did not differ significantly among the techniques. These findings provide valuable insights for colorectal surgeons, facilitating the selection of optimal surgical techniques for the management of UC.