A Laparoscopic Approach Does Reduce Short-Term Complications in Patients Undergoing Ileal Pouch-Anal Anastomosis

Fleming, Fergal J.; Francone, Todd D.; Kim, Michael J.; Gunzler, Douglas D.; Messing, Susan; Monson, J. R. T.

doi:10.1007/dcr.0b013e3181fb4232

Cited by 81 publications

(41 citation statements)

References 27 publications

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“…Nonetheless, a recent publication suggests that the technique is gaining traction with 51% of restorative proctocolectomies being performed with laparoscopy at American College of Surgeons National Surgical Quality Improvement Program-participating institutions. 8 As in all complex operations, proficiency and efficiency in performing the laparoscopic total proctocolectomy comes with a step-wise approach. 9 Mastery of the total colectomy with the common rate-limiting step of transverse colon mobilization and safe ligation of its mesocolon is necessary.…”

Section: Discussionmentioning

confidence: 99%

Technical Considerations in Laparoscopic Total Proctocolectomy

Byrn

2012

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Total proctocolectomy, whether restorative or terminating with an end ileostomy, is an advanced laparoscopic procedure. The goal of this publication is to address specific techniques unique to the operation of laparoscopic total proctocolectomy and review the basics of laparoscopic colon and rectal resections. As in all complex operations, proficiency and efficiency in performing the laparoscopic total proctocolectomy comes with a step-wise approach. Respectable operating room times and true patient benefits may take more than safe reliable, technique; however, and only after a significant experience has been gained will the learning curve plateau.

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Section: Discussionmentioning

confidence: 99%

Technical Considerations in Laparoscopic Total Proctocolectomy

Byrn

2012

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…99 A comparison of the results from 339 laparoscopic IPAA and 337 open IPAA from the NSQIP registry revealed a marked reduction of both postoperative major and minor complications after laparoscopic surgery compared with open surgery (OR 0.67 and 0.44, respec tively). 102 However, a metaanalysis from the Cochrane foundation, including 11 studies and 253 patients who underwent laparoscopic or open IPAA surgery, showed no difference in postoperative mortality or post operative morbidity between the two approaches. 103 Unsurprisingly, this metaanalysis confirmed the shorter time to recovery of bowel function (weighted mean dif ference 1.96 days) and length of stay after laparoscopic approach (weighted mean difference 2.66 days), as compared to the open approach, confirming the trend observed in the comparative studies (studies described in Supplementary Table 3).…”

Section: Postoperative Morbiditymentioning

confidence: 98%

Surgical management of IBD—from an open to a laparoscopic approach

Maggiori

Panis

2013

Nat Rev Gastroenterol Hepatol

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Surgery is a key feature of IBD management. Up to 70% of patients with Crohn's disease and 35% of patients with ulcerative colitis will require surgery during the course of their disease. This Review provides an overview of IBD surgical management, focusing on the potential benefits and drawbacks of laparoscopy compared with open surgery. Emergency and elective indications for both laparoscopic and open surgery are detailed for patients with ulcerative colitis and Crohn's disease. Evidence-based comparative results of these surgical approaches are discussed, along with factors that influence patient outcomes. Upcoming new techniques for IBD surgical management, including single-port surgery, are also presented.

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“…It offers both cosmetic advantages and some short term advantages, such as a possible reduction in perioperative complications [13] . Long term advantages include fewer incisional hernias and fewer adhesions [14] with a significant impact on female fertility in UC patients [15] .…”

Section: Introductionmentioning

confidence: 99%

Surgery for inflammatory bowel disease in the era of laparoscopy

Sica¹,

Biancone²

2013

WJG

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During the course of inflammatory bowel disease (IBD), surgery may be needed. Approximately 20% of patients with ulcerative colitis (UC) will require surgery, whereas up to 80% of Crohn's disease (CD) patients will undergo an operation during their lifetime. For UC patients requiring surgery, total proctocolectomy and ileoanal pouch anastomosis (IPAA) is the operation of choice as it provides a permanent cure and good quality of life. Nevertheless a permanent stoma is a good option in selected patients, especially the elderly. Minimally invasive surgery has replaced the conventional open approach in many specialized centres worldwide. Laparoscopic colectomy and restorative IPAA is rapidly becoming the standard of care in the treatment of UC requiring surgery, whilst laparoscopic ileo-cecal resection is already the new gold standard in the treatment of complicated CD of terminal ileum. Short term advantages of laparoscopic surgery includes faster recovery time and reduced requirement for analgesics. It is, however, in the long term that minimally invasive surgery has demonstrated its superiority over the open approach. A better cosmesis, a reduced number of incisional hernias and fewer adhesions are the long term advantages of laparoscopy in IBD surgery. A reduction in abdominal adhesions is of great benefit when a second operation is needed in CD and this influences positively the pregnancy rate in young women undergoing restorative IPAA. In developing the therapeutic plan for IBD patients it should be recognized that the surgical approach to the abdomen has changed and that surgical treatment of complicated IBD can be safely performed with a true minimally invasive approach with great patient satisfaction.

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A Laparoscopic Approach Does Reduce Short-Term Complications in Patients Undergoing Ileal Pouch-Anal Anastomosis

Cited by 81 publications

References 27 publications

Technical Considerations in Laparoscopic Total Proctocolectomy

Technical Considerations in Laparoscopic Total Proctocolectomy

Surgical management of IBD—from an open to a laparoscopic approach

Surgery for inflammatory bowel disease in the era of laparoscopy

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