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.