Laparoscopic Versus Open Restorative Proctocolectomy for Familial Adenomatous Polyposis

Campos, Fábio Guilherme; Camargo, Mariane Gouveia Monteiro de; Cesconetto, Daniele Menezes; Nahas, Sérgio Carlos; Cecconello, Ivan

doi:10.1089/lap.2017.0397

Cited by 19 publications

(15 citation statements)

References 30 publications

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“…Dear Editor, Total proctocolectomy can be performed with laparotomy or laparoscopic surgery [1]. Laparotomy is less difficult but is thought to be more traumatic, because the incision needs to extend from the xiphoid process to the pubic symphysis.…”

Section: Supporting Informationmentioning

confidence: 99%

Laparoscopic clockwise three‐stage radical total proctocolectomy – a video vignette

Zhang

Cao

et al. 2020

Colorectal Disease

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and submucosa is carried out with the jaws as close to the anal canal wall as possible, dissecting the haemorrhoidal plexus off the fibres of the internal anal sphincter. Finally, with the LigaSure TM Small Jaw Open Sealer, the haemorrhoidal pedicle is reached and the haemorrhoidal tissue is freed from the internal sphincter muscle fibres at this level. With the jaws of the device applied perpendicularly, the pedicle is divided. The wound is checked for haemostasis. The same manoeuvre is performed when excising the remaining two haemorrhoidal complexes. It is crucial to preserve intact tissues between excisional wounds in the anal canal and perianal skin between sites of incision of another haemorrhoidal complex. The size of the excisional wound should be equal to or less than the width of the mucocutaneous bridge. This method is used to avoid postoperative stricture. Postoperative follow-up of the patient at 1 month showed high efficacy of the procedure. This technique avoids any suturing, thus minimizing pain and intra-operative complications.

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Section: Supporting Informationmentioning

confidence: 99%

Laparoscopic clockwise three‐stage radical total proctocolectomy – a video vignette

Zhang

Cao

et al. 2020

Colorectal Disease

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“…However, national publications on the subject are scarce 3,[9][10][11][12] , especially with regards to morbidity and mortality, QoL, and pouch function. This study aims to evaluate the surgical results of IPAA, mainly in terms of complications, intestinal function, QoL, and respective relationships with the socio-demographic and clinical We included patients over 18 years, who underwent PCT-IPAA, agreed to participate in the study, and signed an informed consent form.…”

Section: Introductionmentioning

confidence: 99%

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis

Cherem-Alves

Lacerda‐Filho

Alves

et al. 2021

Rev. Col. Bras. Cir.

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Purpose: restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice in some cases of familial adenomatous polyposis (FAP) and ulcerative colitis (UC). IPAA allows complete removal of the diseased colon and rectum, however, it is associated with substantial morbidity and potential consequences to patients’ quality of life (QoL). Aims: to evaluate the surgical results, functional outcomes and QoL after IPAA; and to examine the impact of surgical complications upon QoL. Methods: we reviewed the records of 55 patients after IPAA, with emphasis on surgical outcomes. Forty patients answered the questionnaires. The Cleveland Global Quality of Life (CGQL), Inflammatory Bowel Disease Questionnaire (IBDQ), and Short Form 36 Health Survey Questionnaire (SF36). Results: the average age was 42.1±14.1 years. 63.6% of the patients were male, and 69.1% had FAP. Operative mortality was 1.8% and overall morbidity was 76.4%. Anastomotic leakage was the most frequent early complication (34.5%). Pouchitis (10.8%) and small bowel obstruction (9.1%) were the most common late complications. Patients with UC had the most severe complications (p=0.014). Pelvic complications did not have a negative effect on functional outcomes or QoL scores. Female patients had decreased pouch evacuation frequency, fewer nocturnal bowel movements, decreased bowel symptom impact on QoL (p=0.012), and better CGQL (p=0.04). Patients with better education had better QoL scores, and patients who had their pouches for more than five years scored lower. Conclusion: the high morbidity has no impact on function or QoL. Bowel function is generally acceptable. QoL is good and affected by sex, education and time interval since IPAA.

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“…The most common surgical procedures for the management of FAP include total abdominal colectomy with ileorectal anastomosis, restorative proctocolectomy with ileal pouch-anal anastomosis, and total proctocolectomy with end ileostomy (4)(5)(6). Restorative proctocolectomy with ileal pouch-anal anastomosis has become the mainstay of surgical management, and a laparoscopic approach has gained significant support in recent years (2,4,5,7,8). Jacobs et al initially described laparoscopic colectomy in 1991, while the first prophylactic laparoscopic ileorectal anastomosis for FAP was reported in 1997 by Milsom et al (6).…”

Section: Introductionmentioning

confidence: 99%

“…Many studies have since compared laparoscopic versus conventional open ileal pouch-anal anastomosis and ileorectal anastomosis to determine the feasibility of laparoscopy in the setting of prophylactic surgery for the management of FAP (2)(3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(14). In comparison to an open approach, benefits of laparoscopic surgery may include shorter length of stay (3,4,10,11,13,14), less need for intra-operative blood transfusion (5,6,8,14), lower rate of desmoid tumors post-operatively (3,9) decreased incidence of post-operative superficial surgical site infection (3,7,10), and a lower rate of minor, short-term complications (4,7,11,13) with no increase in major, longterm complications (11). However, many of these analyses included adult patients, cohorts consisting of both patients with FAP and ulcerative colitis, and/or were small singleinstitution studies and are thus not widely generalizable to the pediatric patient population.…”

Section: Introductionmentioning

confidence: 99%

“…While evidence supports that a laparoscopic approach for elective, prophylactic treatment of FAP in pediatric patients is at least as safe as open technique, the data regarding possible advantages of a minimally invasive approach remain limited (2,3,(4)(5)(6)8,11,13,14). Alternatively, operative duration has consistently been found to be longer with a laparoscopic approach, which is reportedly associated with higher overall costs (4,7,8,13,14). Further investigation is needed to determine if the outcomes following laparoscopic surgery provide an advantage significant enough to justify the potential increased costs of the procedure for this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic colectomy for children with familial adenomatous polyposis: resource utilization and outcomes for open and laparoscopic surgery

Ferrantella¹,

Saberi²,

Willobee³

et al. 2021

Transl Gastroenterol Hepatol

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Background: Laparoscopic approach for the surgical management of familial adenomatous polyposis (FAP) has become increasingly common for pediatric patients. The purpose of this study was to compare shortterm outcomes and resource utilization between open and laparoscopic surgery for prophylactic colectomy in children with FAP. Methods: The Kids' Inpatient Database (2009 and 2012) was analyzed for children (age ≤20 years) with FAP that underwent prophylactic total colectomy or proctocolectomy. Patient demographics, treating hospital characteristics, hospital charges, and short-term outcomes were compared according to the surgical technique utilized (open versus laparoscopic).Results: Overall, we identified 216 patients with FAP that underwent elective total colectomy, of which 95 cases were performed by open surgery and 121 were done laparoscopically. The majority of patients were treated at large, not-for-profit, urban teaching hospitals, and the median age was equal (16 years) in both groups. Complications that were more common for open procedures included accidental perforation or hemorrhage (4% vs. 0%, P=0.023), reopening of surgical site (3% vs. 0%, P=0.049), and pneumonia (3% vs. 0%, P=0.049). Simultaneous proctectomy was performed more commonly in the open cohort (91% vs. 71%, P<0.001) as well as ileostomy creation (74% vs. 49%, P<0.001). The median length of stay was similar in the open and laparoscopic groups (7 vs. 6 days, P=0.712). Median total hospital charges were also similar

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Laparoscopic Versus Open Restorative Proctocolectomy for Familial Adenomatous Polyposis

Abstract: (1) LAP IPAA is a safe procedure associated with a low conversion rate, (2) short-term results showed no clear advantages for both approaches, and (3) a greater risk of major late complications and late reoperations should be expected after open procedures.

Cited by 19 publications

References 30 publications

Laparoscopic clockwise three‐stage radical total proctocolectomy – a video vignette

Laparoscopic clockwise three‐stage radical total proctocolectomy – a video vignette

Surgical results and quality of life of patients submitted to restorative proctocolectomy and ileal pouch-anal anastomosis

Prophylactic colectomy for children with familial adenomatous polyposis: resource utilization and outcomes for open and laparoscopic surgery

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