Laparoscopically assisted colectomy and ileoanal pouch procedure with and without protective ileostomy

被引:72
作者
Kienle, P
Weitz, J
Benner, A
Herfarth, C
Schmidt, J
机构
[1] Heidelberg Univ, Dept Surg, D-69120 Heidelberg, Germany
[2] DKFZ, Cent Unit Biostat, German Canc Res Ctr, D-69120 Heidelberg, Germany
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2003年 / 17卷 / 05期
关键词
laparoscopically assisted proctocolectomy; ileoanal pouch; ileostomy;
D O I
10.1007/s00464-002-9159-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Apart from an obviously better cosmetic situation, there is controversy on the actual benefit of laparoscopic and laparoscopically assisted techniques in restorative proctocolectomy. The need for a protective ileostomy remains unclear. Methods: Fifty-nine consecutive patients with ulcerative colitis and familial polyposis were included in this prospective cohort study. The colon was mobilized laparoscopically with a four-trocar technique, facilitating vascular dissection, rectal resection, and ileoanal pouch construction to be done through a Pfannenstiel incision. A protective ileostomy was constructed only in patients where the operation was difficult or where the anastomosis was under tension. Intra- and postoperative data were recorded; statistical analyses were performed by exact logistic regression. Results: Laparoscopic mobilisation was successful in 54 patients (91.2%). Two patients had to be primarily converted because of exceeding the set time limit; 3 other patients had to have an additional median laparotomy. These 5 patients all had an increased body mass index (BMI), which was a statistically significant risk factor for failure of the laparoscopic technique. 18.6% of patients developed major complications (n = 11). Nine patients required secondary ileostomies; all of them either were under high dose immunosuppressants (n = 5) or had an increased BMI (average 28.42 kg/m(2)). Failure of the laparoscopic technique was associated with major complications. Conclusion: Laparoscopically assisted restorative proctocolectomy is technically feasible; an increased BMI is a relevant risk factor for failure. The minimally invasive approach probably does not reduce the need for a protective ileostomy in selected patients. The selection criteria for the addition or omission of a protective ileostomy in minimally invasive restorative proctocolectomy remain to be clearly defined.
引用
收藏
页码:716 / 720
页数:5
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