Abstract: Objective: To compare the short-term and long-term outcomes between laparoscopic and open total proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC).
Methods:The retrospective cohort study was conducted. The clinical data of 150 UC patients who underwent total proctocolectomy with IPAA in the Renji Hospital of Shanghai Jiaotong University between January 2003 and December 2016 were collected. Among 150 patients, 87 undergoing laparoscopic total proctocolectomy with IPAA and 63 undergoing open total proctocolectomy with IPAA were respectively allocated into the laparoscopy group and open group. Observation indicators: (1) comparisons of intra-and post-operative situations; (2) postoperative complications; (3) follow-up situation. Follow-up using outpatient examination and telephone interview was performed to detect postoperative recovery and complications up to December 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Comparison between groups of count data was analyzed using the chi-square test.
Results:(1) Comparisons of intra-and post-operative situations: operation time, volume of intraoperative blood loss, time of initial intestinal stoma exsufflation and duration of hospital stay were respectively (306±3)minutes, (197±12)mL, (62.1± 1.8)hours, (8.2±0.4)days in the laparoscopy group and (224±4)minutes, (308±24)mL, (75.6±2.0)hours, (10.1±0.6)days in the open group, with statistically significant difference between groups (t=16.23, 4.33, 5.03, 2.61, P<0.05). All patients discharged successfully from hospital. All the 150 patients underwent stoma reversion of ileum at 3- 12 months postoperatively, and the average time in the laparoscopy group and open group was respectively (6.0±5.6)months and (6.0±4.6)months, with no statistically significant difference between groups (t=0.01, P>0.05). (2) Postoperative complications: cases with postoperative wound infection, retention of urine and frequency of defecation > 4 times / day were respectively 2, 8, 21 in the laparoscopy group and 8, 15, 29 in the open group, with statistically significant differences between groups (x²=5.25, 4.37, 0.96, P<0.05). The cases with postoperative intestinal obstruction, anastomotic leakage, pelvic infection, pouch infection, pouch-related Crohn′s disease and hyperplasia of ileal pouch were respectively 3, 10, 5, 23, 2, 1 in the laparoscopy group and 8, 7, 4, 24, 1, 0 in the open group, with no statistically significant differences between groups (x²=3.65, 0.11, 0.01, 0.96, 0.17, 0.82, P>0.05). Patients with postoperative complications were improved by acid suppression, fasting, anti-infection and fluid infusion. (3) Follow-up situation: 150 patients were followed up for 12- 60 months, with a median time of 48 months. There was no abnormality of postoperative anastomotic stoma and intestinal mucosa through comparison of colonoscopy results between pre-operation and 5 year postoperatively. During the follow-up, 50 patients had shapeless stool and irregular defecation (times > 4 times / day) at 3 years after stoma reversion of small intestine bypass, including 21 in the laparoscopy group and 29 in the open group, with a statistically significant differences between groups (x²=4.72, P<0.05). Eleven and 10 patients in the laparoscopy group and open group had shapeless stool and irregular defecation at 5 years postoperatively, but status were improved compared with the preoperative status, with no statistically significant difference between groups (x²=0.32, P>0.05).
Conclusion:The security of laparoscopic total proctocolectomy with IPAA for UC is equivalent to that of open total proctocolectomy, with the better short-term and long-term outcomes.