Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results

Gianluca M Sampietro, Francesco Colombo, Alice Frontali, Caterina M Baldi, Stefania Carmagnola, Andrea Cassinotti, Alessandra Dell'Era, Alessandro Massari, Paola Molteni, Dario Dilillo, Paolo Fociani, Massimo Tonolini, Giovanni Maconi, Paolo Fiorina, Fabio Corsi, Roberto Bianco, Manuela Nebuloni, Gianvincenzo Zuccotti, Sandro Ardizzone, Diego Foschi

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.

AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients.

METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation.

RESULTS: From July 2007 to July 2016, 160 patients entered the study. 50.6% underwent a 3-stage procedure and 49.4% a 2-stage procedure. Mortality and morbidity were 0.6% and 24.6%. Conversion rate was 3.75%. 8.7% septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter disease duration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1% and 3.7%.

CONCLUSION: A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.

Original languageEnglish
Pages (from-to)1283-1291
Number of pages9
JournalDigestive and Liver Disease
Volume50
Issue number12
DOIs
Publication statusPublished - Dec 2018

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Restorative Proctocolectomy
Inflammatory Bowel Diseases
Prospective Studies
Safety
Morbidity
Ileostomy
Mortality
Colectomy
Nutritional Status
Reoperation
Hospitalization
Emergencies
Steroids

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Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results. / Sampietro, Gianluca M; Colombo, Francesco; Frontali, Alice; Baldi, Caterina M; Carmagnola, Stefania; Cassinotti, Andrea; Dell'Era, Alessandra; Massari, Alessandro; Molteni, Paola; Dilillo, Dario; Fociani, Paolo; Tonolini, Massimo; Maconi, Giovanni; Fiorina, Paolo; Corsi, Fabio; Bianco, Roberto; Nebuloni, Manuela; Zuccotti, Gianvincenzo; Ardizzone, Sandro; Foschi, Diego.

In: Digestive and Liver Disease, Vol. 50, No. 12, 12.2018, p. 1283-1291.

Research output: Contribution to journalArticle

Sampietro, GM, Colombo, F, Frontali, A, Baldi, CM, Carmagnola, S, Cassinotti, A, Dell'Era, A, Massari, A, Molteni, P, Dilillo, D, Fociani, P, Tonolini, M, Maconi, G, Fiorina, P, Corsi, F, Bianco, R, Nebuloni, M, Zuccotti, G, Ardizzone, S & Foschi, D 2018, 'Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results', Digestive and Liver Disease, vol. 50, no. 12, pp. 1283-1291. https://doi.org/10.1016/j.dld.2018.05.009
Sampietro, Gianluca M ; Colombo, Francesco ; Frontali, Alice ; Baldi, Caterina M ; Carmagnola, Stefania ; Cassinotti, Andrea ; Dell'Era, Alessandra ; Massari, Alessandro ; Molteni, Paola ; Dilillo, Dario ; Fociani, Paolo ; Tonolini, Massimo ; Maconi, Giovanni ; Fiorina, Paolo ; Corsi, Fabio ; Bianco, Roberto ; Nebuloni, Manuela ; Zuccotti, Gianvincenzo ; Ardizzone, Sandro ; Foschi, Diego. / Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results. In: Digestive and Liver Disease. 2018 ; Vol. 50, No. 12. pp. 1283-1291.
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abstract = "BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients.METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation.RESULTS: From July 2007 to July 2016, 160 patients entered the study. 50.6{\%} underwent a 3-stage procedure and 49.4{\%} a 2-stage procedure. Mortality and morbidity were 0.6{\%} and 24.6{\%}. Conversion rate was 3.75{\%}. 8.7{\%} septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter disease duration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1{\%} and 3.7{\%}.CONCLUSION: A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.",
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TY - JOUR

T1 - Totally laparoscopic, multi-stage, restorative proctocolectomy for inflammatory bowel diseases. A prospective study on safety, efficacy and long-term results

AU - Sampietro, Gianluca M

AU - Colombo, Francesco

AU - Frontali, Alice

AU - Baldi, Caterina M

AU - Carmagnola, Stefania

AU - Cassinotti, Andrea

AU - Dell'Era, Alessandra

AU - Massari, Alessandro

AU - Molteni, Paola

AU - Dilillo, Dario

AU - Fociani, Paolo

AU - Tonolini, Massimo

AU - Maconi, Giovanni

AU - Fiorina, Paolo

AU - Corsi, Fabio

AU - Bianco, Roberto

AU - Nebuloni, Manuela

AU - Zuccotti, Gianvincenzo

AU - Ardizzone, Sandro

AU - Foschi, Diego

N1 - Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

PY - 2018/12

Y1 - 2018/12

N2 - BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients.METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation.RESULTS: From July 2007 to July 2016, 160 patients entered the study. 50.6% underwent a 3-stage procedure and 49.4% a 2-stage procedure. Mortality and morbidity were 0.6% and 24.6%. Conversion rate was 3.75%. 8.7% septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter disease duration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1% and 3.7%.CONCLUSION: A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.

AB - BACKGROUND: Laparoscopic ileo-pouch-anal anastomosis (IPAA) has been reported as having low morbidity and several advantages.AIMS: To evaluate safety, efficacy and long-term results of laparoscopic IPAA, performed in elective or emergency settings, in consecutive unselected IBD patients.METHODS: All the patients received totally laparoscopic 2-stage (proctocolectomy and IPAA - stoma closure) or 3-stage (colectomy - proctectomy and IPAA - stoma closure) procedure according to their presentation.RESULTS: From July 2007 to July 2016, 160 patients entered the study. 50.6% underwent a 3-stage procedure and 49.4% a 2-stage procedure. Mortality and morbidity were 0.6% and 24.6%. Conversion rate was 3.75%. 8.7% septic complications were associated with steroids and Infliximab treatment (p = 0.0001). 3-stage patients were younger (p = 0.0001), with shorter disease duration (p = 0.0001), minor ASA scores of 2 and 3 (p = 0.0007), lower inflammatory index and better nutritional status (p = 0.003 and 0.0001), fewer Clavien-Dindo's grade II complications (p = .0001), reduced rates of readmission and reoperation at 90 days (p = 0.03), and shorter hospitalization (p = .0001), but with similar pouch and IPAA leakage, compared to 2-stage patients. 8 years pouch failure and definitive ileostomy were 5.1% and 3.7%.CONCLUSION: A totally laparoscopic approach is safe and feasible, with very low mortality and morbidity rates and very low conversion rate, even in multi-stage procedures and high-risk patients.

U2 - 10.1016/j.dld.2018.05.009

DO - 10.1016/j.dld.2018.05.009

M3 - Article

C2 - 29914803

VL - 50

SP - 1283

EP - 1291

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

SN - 1590-8658

IS - 12

ER -