Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial

Abstract

Objective: The aim of the study was to evaluate postoperative recovery after hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis in a randomized controlled trial.

Methods: Sixty patients were randomized for hand-assisted laparoscopic (n = 30) or open surgery (n = 30). Primary outcome parameter was postoperative recovery in the 3 months after surgery, measured by quality of life questionnaires (SF-36 and GIQLI). Secondary parameters were postoperative morphine requirement and surgical parameters, viz. operating time, morbidity, hospital stay, and costs.

Results: There was no difference between the 2 procedures in quality of life assessment in the 3 months after surgery. There was a significant decline in quality of life on all scales of the SF-36 (P < 0.001) and total GIQLI score (P < 0.001) in the first 2 weeks in both groups (no significant difference between the groups). Quality of life returned to baseline levels after 4 weeks. Operating times were longer in the laparoscopic group compared with the open group (210 and 133 minutes, respectively; P < 0.001). No significant differences were found in morphine requirement. Neither morbidity nor postoperative hospital stay differed between the laparoscopic and open group (20% versus 17%, in 10 versus 11 days, respectively). Median overall costs were 16.728 for the hand-assisted laparoscopic procedure and 13.406 for the open procedure (P = 0.095).

Conclusions: Recovery measured using quality of life questionnaires is comparable for hand-assisted laparoscopic or open restorative proctocolectomy with ileal pouch anal anastomosis. The laparoscopic approach is as safe, but more costly than the open procedure.

FIGURE 1. Hand-assisted laparoscopic proctocolectomy.

FIGURE 2. Trial flow diagram.

FIGURE 3. Postoperative pain as measured with VAS scores (mean ± 2 SEM). The x-axis represents the time after surgery. The gray error bars represent the laparoscopic group; the black error bars represent the open group.

FIGURE 4. Results of postoperative recovery measured with SF-36 questionnaire (mean ± 2 SEM). The x-axis represents the time when the questionnaires were done, before and after surgery. The gray bars represent the laparoscopic group; the black bars represent the open group. The upper 4 graphs show the scales on which the most important differences were anticipated, viz. physical function, physical as it affects one's role, social function, and bodily pain.

FIGURE 5. Results of postoperative recovery measured with GIQLI questionnaire (mean ± 2 SEM). The x-axis represents the time when the questionnaires were done, before and after surgery. The gray bars represent the laparoscopic group; the black bars represent the open group.