Laparoscopic emergency and elective surgery for ulcerative colitis

L Fowkes, K Krishna, A Menon, G L Greenslade, A R Dixon
Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland 2008, 10 (4): 373-8

OBJECTIVE: To analyse surgical outcomes of fulminate and medically resistant ulcerative colitis (UC) carried out laparoscopically.

METHOD: A prospective database identified 69 consecutive patients who underwent surgery for UC under the senior author over a 5-year period to April 2006.

RESULTS: Thirty-two patients (18 male patients), median BMI 26, underwent laparoscopic subtotal colectomy (LSTC): 22 acute emergencies, 10 refractory to medical therapy and unfit for restorative proctocolectomy. All were receiving iv steroids; azathioprine (7), cyclosporin (5). The median operation time was 135 min (65-280). There was one conversion. Twenty-nine patients have subsequently undergone completion proctectomy and W-pouch formation [24 patients were performed laparoscopically - laparoscopic completion proctectomy (LCP)]; widespread adhesions precluded in five patients. Twenty-six patients underwent restorative laparoscopic proctocolectomy (LRP) - one conversion. Twenty patients underwent W-pouch reconstruction via a Pfannenstiel incision. Six J-pouches were constructed and returned via the ileostomy site. Three underwent a laparoscopic pan-proctocolectomy (LPPC); one conversion. Eight patients underwent open STC. The median time to normal diet was 48 h (1-7 days) for LSTC/LCP and 36 h (1-5 days) for LRP. There were two major complications following LRP, two following LSTC, one following LCP, one following LPPC and five following open surgery. Median hospital stay was 8 days (6-72) for LSTC, 7 days (6-9) for LCP and 5 days (3-45) for LRP. There were six 30-day readmissions following laparoscopic surgery (DVT, reactive depression, ileostomy hold up (2), abdominal pain and high output ileostomy).

CONCLUSION: Laparoscopic subtotal and restorative proctocolectomies in fulminate and medically resistant UC are feasible, safe and largely predictable operations that allow for early hospital discharge. Laparoscopic colectomy facilitates subsequent proctectomy and pouch construction.

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