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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    Sampietro, G. M., Colombo, F., Frontali, A., Baldi, C. M., 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, 50(12), 1283-1291. https://doi.org/10.1016/j.dld.2018.05.009