Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2016; 8(8): 578-582
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.578
Hand-assisted laparoscopic restorative proctocolectomy for ulcerative colitis
Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda
Norimitsu Shimada, Hiroki Ohge, Raita Yano, Naoki Murao, Norifumi Shigemoto, Shinnosuke Uegami, Yusuke Watadani, Kenichiro Uemura, Yoshiaki Murakami, Taijiro Sueda, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima 734-8551, Japan
Author contributions: All authors contribute equally to this work; and Shimada N designed the study and wrote manuscript.
Institutional review board statement: The study was reviewed and approved by the Hiroshima University Hospital Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent for this study, because the clinical data were analyzed anonymously and retrospectively which were obtained after each patient agreed to treatment without additional invasion. For full disclosure, the details of the study are published on the home page of Hiroshima University.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Norimitsu Shimada, Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan. shimada@hiroshima-u.ac.jp
Telephone: +81-82-2575216 Fax: +81-82-2575219
Received: March 24, 2016
Peer-review started: March 25, 2016
First decision: May 17, 2016
Revised: May 23, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 27, 2016
Processing time: 154 Days and 22.1 Hours
Abstract
AIM

To evaluate the utility of hand-assisted laparoscopic restorative proctocolectomy (HALS-RP) compared with the conventional open procedure (OPEN-RP).

METHODS

Fifty-one patients who underwent restorative total proctocolectomy with rectal mucosectomy and ileal pouch anal anastomosis between January 2008 and July 2015 were retrospectively analyzed. Twenty-three patients in the HALS-RP group and twenty-four patients in the OPEN-RP group were compared. Four patients who had purely laparoscopic surgery were excluded. Restorative total proctocolectomy was performed with mucosectomy and a hand-sewn ileal-pouch-anal anastomosis. Preoperative comorbidities, intraoperative factors such as blood loss and operative time, postoperative complications, and postoperative course were compared between two groups.

RESULTS

Patients in both groups were matched with regards to patient age, gender, and American Society of Anesthesiologists score. There were no significant differences in extent of colitis, indications for surgery, preoperative comorbidities, and preoperative medications in the two groups. The median operative time for the HALS-RP group was 369 (320-420) min, slightly longer than the OPEN-RP group at 355 (318-421) min; this was not statistically significant. Blood loss was significantly less in HALS-RP [300 (230-402) mL] compared to OPEN-RP [512 (401-1162) mL, P = 0.003]. Anastomotic leakage was noted in 3 patients in the HALS-RP group and 2 patients in the OPEN-RP group (13% vs 8.3%, NS). The rates of other postoperative complications and the length of hospital stay were not different between the two groups.

CONCLUSION

HALS-RP can be performed with less blood loss and smaller skin incisions. This procedure is a feasible technique for total proctocolectomy for ulcerative colitis.

Keywords: Hand-assisted laparoscopic surgery; Ulcerative colitis; Laparoscopic surgery; Proctocolectomy

Core tip: This is a retrospective study to evaluate the utility of hand-assisted laparoscopic restorative proctocolectomy (HALS-RP) for ulcerative colitis (UC). Fifty-one patients underwent restorative proctocolectomy, and twenty-three patients in the HALS-RP were compared with twenty-four patients in the conventional open surgery group (OPEN-RP). The mean operative time for the HALS-RP group was not different to OPEN-RP group, but blood loss was significantly less in HALS-RP compared to OPEN-RP. HALS is a feasible procedure for restorative proctocolectomy for UC with small skin incision.