Laparoscopic ileal pouch-anal anastomosis in patients with chronic ulcerative colitis and primary sclerosing cholangitis: a case-matched study.

PURPOSE

This study was designed to compare short-term outcomes after laparoscopic ileal pouch-anal anastomosis with those of open ileal pouch-anal anastomosis in patients with both sclerosing cholangitis and ulcerative colitis.

METHODS

Sixteen patients with sclerosing cholangitis and ulcerative colitis undergoing laparoscopic ileal pouch-anal anastomosis were matched with 16 open ileal pouch control subjects by sex, American Society of Anesthesiologists' score, age, and body mass index.

RESULTS

Operative mortality was zero. Operative time was longer in the laparoscopic group (500 +/- 125.8 vs. 381.8 +/- 60.9 minutes, P = 0.03). Thirty-day complications were not significantly different between groups (laparoscopic 25 percent vs. open 43.7 percent, P = 0.26). Length of stay was significantly shorter in the laparoscopic group (5.3 +/- 1.3 days vs. 9.9 +/- 3.3 days open, P < 0.001). Average return of gastrointestinal function was 2.5 days in the laparoscopic group and 4.8 days in the open group (P = 0.001). Time to soft diet was three days in the laparoscopic group and six days in the open group (P < 0.001). All patients were alive and all pouches were intact at last follow-up.

CONCLUSIONS

Laparoscopic ileal pouch-anal anastomosis is feasible with apparent safety in patients with primary sclerosing cholangitis, resulting in shorter duration of hospital stay and quicker return of gastrointestinal function compared with the open procedure with no difference in perioperative complications, reoperations, and readmissions.