Laparoscopic restorative proctocolectomy

被引:59
作者
Kienle, P
Z'graggen, K
Schmidt, J
Benner, A
Weitz, J
Büchler, MW
机构
[1] Heidelberg Univ, Dept Surg, D-6900 Heidelberg, Germany
[2] German Canc Res Ctr, Cent Unit Biostat, D-6900 Heidelberg, Germany
关键词
D O I
10.1002/bjs.4772
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Restorative proctocolectomy is increasingly being performed using minimally invasive surgery. In published series laparoscopically assisted techniques have usually included a suprapubic incision to enable major parts of the operation to be done openly. Methods: Fifty consecutive patients with familial adenomatous polyposis or ulcerative colitis underwent laparoscopic restorative proctocolectomy using only a small perumbilical incision of 4 cm or less for vascular dissection and pouch formation; all other steps were performed entirely laparoscopically. Logistic regression was used for statistical analysis. Results: In four patients (8 per cent) the operation was converted to an open procedure. The diagnosis of ulcerative colitis was associated with a higher overall rate of complications (P = 0.011), and an increased body mass index (BMI) with a higher rate of major complications (P = 0.050). The occurrence of wound infection was related to the diagnosis of ulcerative colitis (P = 0.049). Conversion resulted in greater blood loss (P = 0.004), but not in a higher complication rate. No patient required a blood transfusion. Patients with an increased BMI and those taking immunosuppressive therapy had a longer hospital stay (P = 0.043). Conclusion: Laparoscopic restorative proctocolectomy is technically feasible. Patients with ulcerative colitis and increased BMI have a higher risk of complications. This minimally invasive technique may reduce the need for perioperative blood transfusion.
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页码:88 / 93
页数:6
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