Abstract

Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results

Sampietro GM1, Colombo F2, Frontali A3, Baldi CM2, Carmagnola S4, Cassinotti A4, Dell'Era A4, Massari A4, Molteni P4, Dilillo D5, Fociani P6, Tonolini M7, Maconi G4, Fiorina P8, Corsi F9, Bianco R7, Nebuloni M6, Zuccotti G10, Ardizzone S4, Foschi D2. Dig Liver Dis. 2018 May 21. pii: S1590-8658(18)30753-9. doi: 10.1016/j.dld.2018.05.009. [Epub ahead of print]
 
     

Author information

1 IBD Surgical Unit, ASST Fatebenefratelli - Sacco, Milan, Italy; Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy. Electronic address: gianluca.sampietro@unimi.it.

2 Division of General Surgery, ASST Fatebenefratelli - Sacco, Milan, Italy.

3 Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy; Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Assistance Publique - Hôpiteau de Paris (AP-HP), Beaujon Hospital, University Denis Diderot, Paris, France.

4 Division of Gastroenterology, ASST Fatebenefratelli - Sacco, Milan, Italy.

5 Division of Pediatrics, ASST Fatebenefratelli - Sacco, Milan, Italy.

6 Division of Pathology, ASST Fatebenefratelli - Sacco, Milan, Italy.

7 Division of Radiology, ASST Fatebenefratelli - Sacco, Milan, Italy.

8 Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy; Division of Endocrinology, ASST Sacco Fatebenefratelli-Sacco, Milan, Italy.

9 Surgery Department, Breast Unit, ICS Maugeri, Pavia, Italy; Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy.

10 Division of Pediatrics, ASST Fatebenefratelli - Sacco, Milan, Italy; International Center for T1D, Pediatric Clinical Research Center Fondazione Romeo ed Enrica Invernizzi, Department of Biomedical and Clinical Science L. Sacco, University of Milan, Italy.

Abstract

BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.

AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients.

METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation.

RESULTS: From July 2007 to July 2016, 160 patients entered the study. 50.6% underwent a 3-stage procedure and 49.4% a 2-stage procedure. Mortality and morbidity were 0.6% and 24.6%. Conversion rate was 3.75%. 8.7% septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter diseaseduration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1% and 3.7%.

CONCLUSION: A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.

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