Restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis: A narrative review

Table 1 Meta-analyses comparing the intra-operative, short-term, and functional outcomes of open vs laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis

Ref.	Number of studies included/N of RCTs	Number of patients	Operative time	Blood loss	Intra-operative mortality	Hospital stay	Post-operative complications	Functional outcomes
Tilney et al[9]	10/1	Open: 178 LS: 175	Higher in LS by 86 minb	Lower in LS by 84 mLb	Not reported	No significant differences	No significant differences	No significant differences1
Ahmed Ali et al[8]	11/1	Open: 354 LS: 253	Higher in LS by 92 minb	Lower in LS by 138 mL	No significant differences	Shorter in LS by 2.12 d	Total Open: 41.5 LS: 37.6 Severe Open: 7.8 LS: 5.1	LS: Shorter time to bowel movement (-1.96 d); no significant difference in daytime and overnight continence, soiling, or urge incontinence
Singh et al[7]	27/1	Open: 1331 LS: 1097	Higher in LS by 70.1 minb	Lower in LS by 89.1 mLb	Not reported	Shorter in LS by 1 d	No significant differences with the exception of wound infection (lower in LS)	LS led to fewer nocturnal bowel movements and reduced pad usage during the day

¹Data based on only 2 studies;

^bP < 0.001. RCT: Randomized controlled trial; LS: Laparoscopic surgery.

Table 2 Studies comparing the intra-operative, short-term, and functional outcomes of open vs laparoscopic restorative proctocolectomy with ileal pouch-anal anastomosis

Ref.	Type of study	Number of patients	Operative time (min)	Blood loss (mL)	Mortality (%)	Hospital stay (d)	Post-operative complications (%)	Functional outcomes
Fajardo et al[10]	Retrospective	Open: 69 LS: 55	Open: 187 ± 52 LS: 266 ± 55e	Open: 284 ± 146 LS: 294 ± 274	Open: 0 LS: 0	Open: 7.8 ± 4.9 LS: 8.4 ± 6.0	Open: 59.4 LS: 50.1	Open: 5.1 ± 2.8 LS: 4.9 ± 4.92
Fleming et al[11]	Retrospective	Open: 339 LS: 337	Patients with an operative time > 336 min Open: 13.7%e LS: 36.6%e	Patients with transfusion Open: 8%a LS: 3.9a	Open: 0.6 LS: 0.5	Open: 7.9 ± 4.8 LS: 7.3 ± 4.3	Major Open: 29.74 LS: 16.84 Minor Open: 18.43 LS: 10.63	Not reported
Causey et al[12]	Retrospective	Open: 148 LS: 299	Not reported	Not reported	Open: 0 LS: 0	Not reported	Open: 18.2b LS: 29.8b	Not reported
Schiessling et al[13]	PRT1	Open: 21 LS: 21	Open: 200 ± 53 LS: 313 ± 52e	Open: 228 ± 119 LS: 261 ± 195	Open: 0 LS: 0	Open: 19.6 ± 20.5 LS: 12.3 ± 5.8	Open: 5 LS: 9.5	Open: 3. 5 ± 2.5 LS: 3.4 ± 2.52
Tajti et al[15]	Retrospective	Open: 22 LS: 23	Open: 185 ± 171c LS: 245 ± 511c	Units of blood transfusion Open: 3 ± 1.9 LS: 2 ± 1.7	Open: Not reported LS: Not reported	Open: 11.6 ± 3.4 LS: 11.5 ± 3.8	Sepsis Open: 27d LS: 0d	Open: 7.83 ± 3.285 LS: 7.81 ± 3.315
Benlice et al[14]	Retrospective	Open: 238 LS: 119	Higher in LS		Not evaluated		Similar incidence of incisional hernia and small bowel obstruction

¹Included patients with ulcerative colitis and familial adenomatous polyposis;

²Days to first ingestion;

³Based on a multivariate analysis: OR = 0.44 (0.27-0.70) (P = 0.01);

⁴Based on a multivariate analysis: OR = 0.67 (0.45–0.99) (P = 0.04);

⁵Number of stools per day.

^aP = 0.02;

^bP = 0.008;

^cP = 0.040;

^dP = 0.007;

^eP < 0.0001. LS: Laparoscopic surgery; PRT: Prospective randomized trial.

Table 3 Studies comparing the mortality and morbidity of 2-stage and 3-stage restorative proctocolectomy with ileal pouch-anal anastomosis

Ref.	Type of study	Number of patients 2- vs 3-stage	Mortality (%)	Post-operative complications (%)	Sepsis/ septic shock (%)	Pouch leak (%)	Wound infection (%)	Intra-abdominal abscess (%)	Bowel obstruction (%)	Pouch failure (%)
2Nicholls et al[27]	Retrospective	2-stage: 57 3-stage: 95	2-stage: 2 3-stage: 0	2-stage: 49 3-stage: 51	2-stage: 20 3-stage: 17	2-stage: 10.3 3-stage: 3.6	2-stage: 9 3-stage: 12	2-stage: 2 3-stage: 1	2-stage: 9 3-stage: 15	2-stage: 2a 3-stage: 9a
Pandey et al[28]	Retrospective	2-stage: 68 3-stage: 50	2-stage: 1.47 3-stage: 0	2-stage: 55.2% 3-stage: 52.2%	Unknown	2-stage: 13.2 3-stage: 8	2-stage: 8.8 3-stage: 7	2-stage: 16.2 3-stage: 6	2-stage: 11.8 3-stage: 9	Unknown
Hicks et al[29]	Retrospective	2-stage: 116 3-stage: 28	2-stage: 0 3-stage: 0	Mean number of complications: 1.18 vs 1.29	Unknown	2-stage: 10.3 3-stage: 3.6	Unknown	2-stage: 21.6 3-stage: 21.4	2-stage: 20.8 3-stage: 3.6c	2-stage: 6.7 3-stage: 3.6
Bikhchandani et al[30]	Retrospective	2-stage: 1452 3-stage: 550	2-stage: 0.4 3-stage: 0	2-stage: 11.5% 3-stage: 9.4%	2-stage: 9.1 3-stage: 7.4	2-stage: 9.4 3-stage: 6.71	2-stage: 10.5 3-stage: 13.11	Unknown	Unknown	Unknown

Differences are not significantly different.

¹Reported as deep organ space infection;

²Studies including patients affected by ulcerative colitis and familial adenomatous polyposis;

^aP < 0.05;

^cP = 0.03.