Laparoscopic Proctocolectomy for Ulcerative Colitis and Crohn’s Disease of the Large Intestine: Short-Term and Long-Term Outcomes of 53 Cases

Abstract

One- or two-stage restorative total colectomy is recognized as surgery of choice when treating ulcerative colitis and Crohn’s disease of the large intestine. The possible advantages of laparoscopic approach are still being discussed. 

The objective of the research was to evaluate postoperative quality of life, short-term and long-term functional outcomes of 53 cases of laparoscopically assisted proctocolectomy for ulcerative colitis and Crohn’s disease of the large intestine in order to improve further application of laparoscopic approach.  

Materials and methods. Primary restorative proctocolectomy with transanal mucosectomy and the ileal pouch-anal anastomosis was performed in 5 patients with ulcerative colitis; total colectomy with low anterior resection of the rectum and double stapling ileal pouch-rectal anastomosis was performed in 8 patients; total proctocolectomy (with abdominoperineal resection of the rectum, terminal ileostomy) was performed in 3 patients with Crohn’s disease and multiple perianal fistulas; total colectomy, low anterior resection of the rectum, and terminal ileostomy (the first stage of surgical treatment) was performed in 37 patients; the second stage restorative surgery (J-pouch construction and the pouch-anal/low rectal anastomosing) was performed in 17 patients. The restorative procedure was followed by temporary diverting ileostomy in all patients.

Results. The conversion to laparotomy was required in 3 (5.7%) cases. In one case during the second stage restorative surgery the urine bladder wall was damaged, and sutured laparoscopically. There was no postoperative mortality. The major complications of the early postoperative period included pelvic abscesses (4 patients), pouch-anal anastomosis leakage (1 patient), postoperative ileus (3 patients), and ileal pouch-perineal fistula (1patient). Stool frequency was about 6 times in a 24 hour period (4-11 times) 12 months after ileostomy closure.  Pouchitis was observed in 4 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 are considered as surgery of choice for ulcerative colitis. The pouch-rectal anastomosing is feasible for Crohn’s disease in individual cases. Total laparoscopic proctocolectomy with intracorporeal ileal pouch construction may be the next step in clinical trials.