Background. One- or two-staged restorative total colectomy is a surgery that has been established for ulcerative colitis (UC) and Crohn disease of the colon (CD). The possible benefits of the laparoscopic approach are still being discussed.
The aim of this study was to evaluate the postoperative quality of life, short- and long-term functional outcomes of 53 cases of laparoscopic-assisted proctocolectomy for UC and CD in purpose to improve further application of the laparoscopic approach.
Primary restorative proctocolectomy with ileal pouch-anal anastomosis was performed in 5 patients; ileal pouch-rectal anastomosis — in 8 patients; total proctocolectomy, end ileostomy (for CD with multiple perianal fistulas) in 3 patients; total colectomy, low anterior resection of the rectum, and terminal ileostomy — in 37 patients; second-stage restorative surgery — in 17 patients. All patients but one had a temporary diverting ileostomy.
Conversion to laparotomy took place in 3 (5.7%) cases. In one case of second-stage restorative surgery the urine bladder wall was wounded, and sutured-on laparoscopically. There was no postoperative mortality. Major morbidity comprised pelvic abscesses (4 patients); pouch-anal anastomosis leakage (1); postoperative ileus (3); ileal pouch fistula (1). Stool frequency was almost identical at six and 12 months after ileostomy closure (mean±sem: (6.1±1.9) and (5.7±2.1) day, respectively). The pouchitis took place in 2 CD patients. Pouch failure occurred in 1 patient due to severe pouchitis and anal incontinence.
Conclusions. Laparoscopic proctocolectomy with extracorporeal ileal pouch construction, transanal mucosectomy, and pouch-anal anastomosis seems to be surgery of choice for UC. Pouch-rectal anastomosing is feasible for CD in selected cases. The total laparoscopic proctocolectomy with intracorporeal ileal pouch construction ought to be the further step for clinical evaluation.