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.
Keywords
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Article info
Publication history
Published online: May 21, 2018
Accepted:
May 9,
2018
Received in revised form:
April 10,
2018
Received:
March 4,
2018
Identification
Copyright
© 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
