AIM: Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy. METHOD: Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database. RESULTS: Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma. CONCLUSION: Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.
AIM: Restorative proctocolectomy performed before the advent of laparoscopy had evolved to frequently omit a diverting stoma. Our aim was to assess the impact of a diverting stoma on postoperative outcomes following laparoscopic restorative proctocolectomy. METHOD: Data on all patients undergoing a laparoscopic restorative proctocolectomy at our institution were prospectively collated in a database. RESULTS: Between November 2004 and February 2010, 71 patients (38 females) underwent laparoscopic restorative proctocolectomy. Indications included familial adenomatous polyposis (n=34), ulcerative colitis (n=35), indeterminate colitis (n=1) and Lynch syndrome (n=1). Laparoscopic restorative proctocolectomy was performed as a one-stage procedure in 49 patients, and after a sub-total colectomy in 22. Seven patients in each group underwent the formation of a diverting stoma. Nine patients required conversion to open surgery. Sixteen patients experienced at least one postoperative complication. The postoperative morbidity was 29% (n=4/14) and 21% (n=12/21) in patients with and without a stoma (p=0.8), and the rate of fistula was 21% and 5%, respectively (p=0.08). Seven percent of patients with a stoma and 16% without stoma had an intra-abdominal collection (p=0.7). Nine patients required reoperation. The reoperation rate was not influenced by the presence or absence of a diverting stoma. CONCLUSION: Laparoscopic restorative proctocolectomy can be performed safely without a diverting stoma in selected patients.
Authors: S-J Baek; E J Dozois; K L Mathis; A L Lightner; S Y Boostrom; R R Cima; J H Pemberton; D W Larson Journal: Tech Coloproctol Date: 2016-04-27 Impact factor: 3.781
Authors: Nathan S Rubalcava; Samir K Gadepalli; Cory N Criss; Natalie A Moreno; Jeremy Adler; James D Geiger Journal: Pediatr Surg Int Date: 2021-06-18 Impact factor: 1.827