Laparoscopic ileal pouch–anal anastomosis reduces abdominal and pelvic adhesions

Abstract

Laparoscopic IPAA results in few adhesions to the anterior abdominal wall or to gynecologic organs. These adhesions were significantly fewer than previously reported for open operations with or without the use of a glycerol hyaluronate/carboxymethylcellulose bioresorbable (GHA/CMC) adhesion barrier.

Outcomes after laparoscopic surgery in children with inflammatory bowel disease

“…While many surgeons believe that the laparoscopic approach is associated with a decreased risk of postoperative bowel obstruction with evidence of decreased risk following laparoscopic ileocolic resection [9], the incidence in those who underwent colorectal procedures (16%) in this series is comparable to the 13-35% rate of bowel obstruction cited in the literature following open IPAA [10]. This is surprising given a recent prospective but noncontrolled study demonstrating at the time of laparoscopic ileostomy closure fewer adhesions to the adnexa and abdominal wall following laparoscopic IPAA [11]. Therefore, although formal comparison is needed, it does not seem that laparoscopic colorectal procedures for IBD are associated with a decrease in the risk of long-term bowel obstruction.…”

Surgical management of ulcerative colitis

“…However, at the present time, there is no evidence of any additional benefit to the patient [7,[26][27][28][29]. In one study laparoscopic IPAA has been shown to result in fewer adhesions to the anterior abdominal wall and the pelvic organs [30]. If it were to be confirmed in large-scale trials that there are fewer episodes of adhesive small bowel obstruction than after open surgery, laparoscopic pouch surgery would become the routine gold standard for all suitable UC patients.…”

Management of inflammatory bowel disease in pregnancy

“…Two studies looking at IRA -one with familial adenomatous polyposis patients, another with UC patients -found pregnancy rates after IRA were similar to controls and greater than rates after IPAA [14,18]. Building off of a recent study showing fewer adhesions with laparoscopic IPAA technique [19], a recent cross-sectional study by Bartels et al suggests pregnancy rates are significantly higher among women who have undergone laparoscopic IPAA versus open IPAA [20]. While more studies in this area are needed, for women requiring surgery and interested in conceiving in the future, IRA or laparoscopic IPAA should be considered as they may result in greater maintenance of fertility compared with open IPAA.…”