Abstract:
BACKGROUND:Inflammatory bowel disease (IBD) patients have a high incidence of wound and overall postoperative complications. A totally laparoscopic approach could potentially reduce these risks. We adopted totally laparoscopic total proctocolectomy (TL-TPC) using the perineal wound for extraction as the procedure of choice in IBD patients who are not candidates for a restorative procedure. This study looks at the TL-TPC results and compares them with our open cohort. METHODS:Prospectively collected data from 52 consecutive patients undergoing TL-TPC from 2002 to 2010 were compared to 31 contemporary patients undergoing open TPC. RESULTS:Demographics and patient characteristics including body mass index were similar. Mean operative times were 340 ± 7 minutes for TL-TPC and 337 ± 9 minutes for open TPC (P = 0.91). Intraoperative blood loss was 228 ± 2 mL for TL-TPC and 484 ± 3 mL for open TPC (P < 0.001). Return of bowel function measured as an ileostomy output >100 mL per 8 hours occurred at 2.7 ± 2.8 days for TL-TPC versus 3.3 ± 1.8 days for open TPC (P = 0.025). The length of stay was 8.4 ± 5.0 days for TL-TPC versus 9.2 ± 3.2 days for open TPC (P = 0.05). The overall complication rate was 43% for TL-TPC versus 65% for open TPC (P = 0.07). Postoperative abdominal wound infections and parastomal hernias occurred in 23% and 10% of open TPC patients, respectively, versus zero (P = 0.001) and 6% (P = 0.67) for TL-TPC. CONCLUSIONS:TL-TPC is therefore considered a safe alternative to open surgery for selected IBD patients not candidates for a restorative procedure.
journal_name
Inflamm Bowel Disjournal_title
Inflammatory bowel diseasesauthors
Holder-Murray J,Zoccali M,Hurst RD,Umanskiy K,Rubin M,Fichera Adoi
10.1002/ibd.21808subject
Has Abstractpub_date
2012-05-01 00:00:00pages
863-8issue
5eissn
1078-0998issn
1536-4844journal_volume
18pub_type
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更新日期:2008-08-01 00:00:00
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更新日期:2007-08-01 00:00:00
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pub_type: 杂志文章
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更新日期:2012-06-01 00:00:00
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doi:
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章,随机对照试验
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