Safety, Feasibility, and Short-term Outcomes of Laparoscopic Ileal-Pouch-Anal Anastomosis

Abstract

LAP-IPAA is equivalent to open IPAA in terms of safety and feasibility. In addition, LAP-IPAA provides significant improvements in short-term recovery outcomes.

Perioperative complications in inflammatory bowel disease

“…A study of 100 consecutive patients undergoing laparoscopic IPAA case matched with 200 open procedures at our institution confirmed the advantages of a minimally invasive approach. 40 In our series, there were no differences observed in perioperative complications between the two techniques (laparoscopic 33%, open 37%). In particular, anastomotic leakage from the pouch was only observed in 1% of patients using either technique.…”

Minimally invasive total proctocolectomy with Brooke ileostomy for ulcerative colitis

“…13 In that study, in which the median age was 32 years, and the oldest patient was 66 years old, the mean operative time was 333 minutes and 230 minutes for the LAP and open group, respectively, and the median LOS was 4 and 7 days, respectively. The conversion rate in that study was 6%, as compared with 4.5% overall in the present study, and postoperative morbidity rates of 33% and 37% for the LAP and open groups, respectively.…”

Hand-assisted hybrid laparoscopic–robotic total proctocolectomy with ileal pouch–anal anastomosis

“…Finally, ergonomic hand and body positioning at the robotic console provides a comfortable operating position for the surgeon [14]. The enhanced optics and fine tissue manipulation afforded by the robotic approach reportedly assist in identification and preservation of critical pelvic structures [3]. Therefore, robotic systems may improve the utilization of minimally invasive techniques in rectal resection by reducing the ergonomic and technical challenges of laparoscopic tissue handling, dissection, and visualization, which is of particular importance in confined spaces such as the pelvic cavity [15].…”

“…Minimally invasive surgical techniques have recently been used to perform large bowel resections for the treatment of both malignant and benign colonic diseases, including FAP and UC. In fact, several studies have demonstrated that minimally invasive colorectal surgery has several advantages over open surgery, including earlier return of bowel function, reduced postoperative pain, and better cosmetic results [3,4]. However, even if laparoscopy has become very popular for colon surgery and is largely used also in rectal surgery, laparoscopic total proctocolectomy with IPAA has not had the same dissemination mostly because of the intrinsic technical limitations of the laparoscopic approach in the deep pelvis and the steep learning curve [5,6].…”