LAPAROSCOPIC ILEAL POUCH-ANAL ANASTOMOSIS IS NOT ASSOCIATED WITH DECREASED
RATES OF INCISIONAL HERNIA AND SMALL BOWEL OBSTRUCTION WHEN COMPARED WITH
OPEN TECHNIQUE: LONG-TERM FOLLOW-UP OF A CASE-MATCHED STUDY
Cigdem Benlice, Luca Stocchi, Meagan Costedio, Emre Gorgun, Tracy Hull, Hermann Kessler, Feza H
Remzi
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio
Background: There is scant data on the presumed long-term advantages of laparoscopic ileal pouch-anal
anastomosis (IPAA), specifically reduction of small bowel obstruction (SBO) and incisional hernia (IH). The aim of
this study was to compare long-term outcomes in open vs. laparoscopic IPAA based on a previous study from our
institution.
Methods: The original 1:2 case-match study examined 119 laparoscopic and 238 open IPAA operated between
1992-2007. Long-term complications including IH clinically detected by a physician, SBO and pouch excision were
retrospectively collected from a prospective database, office visits and patient charts. Laparoscopic abdominal
colectomy followed by rectal dissection under direct vision (using lower midline or Pfannenstiel incision) and
converted cases were analyzed within the laparoscopic group.
Results: Groups were comparable with respect to age, gender, body mass index and extent of resection (completion
proctectomy vs. proctocolectomy), consistent with the original case-matching. Anti-adhesion barrier use had also
been similar. Mean follow-up was significantly longer in the open group (9.6 years vs. 8.1 years, respectively,
p=0.008). The incidence of IH, SBO requiring hospital admission, SBO requiring surgery, and pouch excision were
similar between the 2 groups (Table). A subgroup analysis within the laparoscopic group comparing 69 patients with
rectal dissection under direct vision vs. 50 patients with laparoscopic rectal dissection indicated statistically similar
incidence of IH (4.3% vs. 8%, respectively, p=0.45), hospital admission and surgery for SBO (34.8% vs. 22%, p=
0.13 and 15.9% vs. 6%, p=0.11, respectively).
Conclusion: Some of the anticipated long-term benefits of laparoscopic IPAA could not be demonstrated in this
cohort. Lack of such long-term benefits should be discussed with patients when proposing a laparoscopic approach.
Completely laparoscopic dissection should be assessed in larger studies to detect possible long-term benefits.
Table. Comparison of demographics and long-term results between laparoscopic and open IPAA.
Conversion
BMI, kg/m2
Anti-adhesion barrier use
Follow-up, months
Incisional hernia
Midline
Ileostomy site
Umbilical port site
Right lower quadrant port site
Pfannenstiel extraction site
Hospital admission for SBO
Surgery for SBO
Pouch excision
Values are reported as mean (SD) or absolute values (%).
Open
(N=238)
N/A
24.9 (4.5)
43 (18.1%)
116 (64)
20 (8.4%)
12
8
N/A
N/A
N/A
62 (26.1%)
Laparoscopic
(N=119)
9 (7.6%)
24.7 (5.1)
23 (19.3%)
98 (50)
7 (5.9%)
1
3
2
1
0
35 (29.4%)
P value
20 (8.4%)
12 (5%)
14 (11.8%)
7 (5.9%)
0.31
0.74
0.66
0.77
0.008
0.4
0.5