NoBlood

Journal:
Britsh Journal of Surgery

Publisher:
Wiley InterScience

Link:
http://www3.interscience.wiley.com/c...56183/ABSTRACT

Contact:
email: M. W. Büchler (Markus_Buechler@med.uni-heidelberg.de)

Laparoscopic restorative proctocolectomy

Background:
Restorative proctocolectomy is increasingly being performed using minimally invasive surgery. In published series laparoscopically assisted techniques have usually included a suprapubic incision to enable major parts of the operation to be done openly.

Methods:
Fifty consecutive patients with familial adenomatous polyposis or ulcerative colitis underwent laparoscopic restorative proctocolectomy using only a small perumbilical incision of 4 cm or less for vascular dissection and pouch formation; all other steps were performed entirely laparoscopically. Logistic regression was used for statistical analysis.

Results:
In four patients (8 per cent) the operation was converted to an open procedure. The diagnosis of ulcerative colitis was associated with a higher overall rate of complications (P = 0·011), and an increased body mass index (BMI) with a higher rate of major complications (P = 0·050). The occurrence of wound infection was related to the diagnosis of ulcerative colitis (P = 0·049). Conversion resulted in greater blood loss (P = 0·004), but not in a higher complication rate. No patient required a blood transfusion. Patients with an increased BMI and those taking immunosuppressive therapy had a longer hospital stay (P = 0·043).

Conclusion:
Laparoscopic restorative proctocolectomy is technically feasible. Patients with ulcerative colitis and increased BMI have a higher risk of complications. This minimally invasive technique may reduce the need for perioperative blood transfusion. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.


Accepted: 25 May 2004
Digital Object Identifier (DOI)