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Total laparoscopic restorative proctocolectomy: are there advantages compared with the open and hand-assisted approaches?

Polle SW, van Berge Henegouwen MI, Slors JF, Cuesta MA, Gouma DJ, Bemelman WA - Dis. Colon Rectum (2008)

Bottom Line: Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age.There were neither conversions nor intraoperative complications.There were no differences in quality of life and total costs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.

ABSTRACT

Purpose: A randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy with open surgery did not show an advantage for the laparoscopic approach. The trial was criticized because hand-assisted laparoscopic restorative proctocolectomy was not considered a true laparoscopic proctocolectomy. The objective of the present study was to assess whether total laparoscopic restorative proctocolectomy has advantages over hand-assisted laparoscopic restorative proctocolectomy with respect to early recovery.

Methods: Thirty-five patients underwent total laparoscopic restorative proctocolectomy and were compared to 60 patients from a previously conducted randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy and open restorative proctocolectomy. End points included operating time, conversion rate, reoperation rate, hospital stay, morbidity, quality of life, and costs. The Medical Outcomes Study Short Form 36 and the Gastrointestinal Quality of Life Index were used to evaluate general and bowel-related quality of life.

Results: Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age. There were neither conversions nor intraoperative complications. Median operating time was longer in the total laparoscopic compared with the hand-assisted laparoscopic group (298 vs. 214 minutes; P < 0.001). Morbidity and reoperation rates in the total laparoscopic, hand-assisted laparoscopic, and open groups were comparable (29 vs. 20 vs. 23 percent and 17 vs.10 vs. 13 percent, respectively). Median hospital-stay was 9 days in the total laparoscopic group compared with 10 days in the hand-assisted laparoscopic group and 11 days in the open group (P = not significant). There were no differences in quality of life and total costs.

Conclusions: There were no significant short-term benefits for total laparoscopic compared with hand-assisted laparoscopic restorative proctocolectomy with respect to early morbidity, operating time, quality of life, costs, and hospital stay.

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Related in: MedlinePlus

Daily and total morphine requirement after TLRP vs. HAL-RP vs. ORP. HAL-RP = hand-assisted laparoscopic restorative proctocolectomy; TLRP = total laparoscopic restorative proctocolectomy; ORP = open restorative proctocolectomy.
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Fig1: Daily and total morphine requirement after TLRP vs. HAL-RP vs. ORP. HAL-RP = hand-assisted laparoscopic restorative proctocolectomy; TLRP = total laparoscopic restorative proctocolectomy; ORP = open restorative proctocolectomy.

Mentions: There was a statistically significant shorter period to oral intake in the TLRP group compared with both other groups (time to resumption of liquid diet, 3 vs. 5 vs. 5 days and normal diet 5 vs. 6 vs. 7 days in the TLRP, HAL-RP, and ORP groups, respectively; P = 0.004 and P = 0.018, respectively). In spite of this, there was no statistical difference in hospital stay between the three groups (Table 2). Although daily and total morphine requirement in the TLRP was lower compared with the HAL-RP and ORP groups, this difference was not statistically significant (Fig. 1).Figure 1


Total laparoscopic restorative proctocolectomy: are there advantages compared with the open and hand-assisted approaches?

Polle SW, van Berge Henegouwen MI, Slors JF, Cuesta MA, Gouma DJ, Bemelman WA - Dis. Colon Rectum (2008)

Daily and total morphine requirement after TLRP vs. HAL-RP vs. ORP. HAL-RP = hand-assisted laparoscopic restorative proctocolectomy; TLRP = total laparoscopic restorative proctocolectomy; ORP = open restorative proctocolectomy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2365983&req=5

Fig1: Daily and total morphine requirement after TLRP vs. HAL-RP vs. ORP. HAL-RP = hand-assisted laparoscopic restorative proctocolectomy; TLRP = total laparoscopic restorative proctocolectomy; ORP = open restorative proctocolectomy.
Mentions: There was a statistically significant shorter period to oral intake in the TLRP group compared with both other groups (time to resumption of liquid diet, 3 vs. 5 vs. 5 days and normal diet 5 vs. 6 vs. 7 days in the TLRP, HAL-RP, and ORP groups, respectively; P = 0.004 and P = 0.018, respectively). In spite of this, there was no statistical difference in hospital stay between the three groups (Table 2). Although daily and total morphine requirement in the TLRP was lower compared with the HAL-RP and ORP groups, this difference was not statistically significant (Fig. 1).Figure 1

Bottom Line: Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age.There were neither conversions nor intraoperative complications.There were no differences in quality of life and total costs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Academic Medical Center, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.

ABSTRACT

Purpose: A randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy with open surgery did not show an advantage for the laparoscopic approach. The trial was criticized because hand-assisted laparoscopic restorative proctocolectomy was not considered a true laparoscopic proctocolectomy. The objective of the present study was to assess whether total laparoscopic restorative proctocolectomy has advantages over hand-assisted laparoscopic restorative proctocolectomy with respect to early recovery.

Methods: Thirty-five patients underwent total laparoscopic restorative proctocolectomy and were compared to 60 patients from a previously conducted randomized, controlled trial comparing hand-assisted laparoscopic restorative proctocolectomy and open restorative proctocolectomy. End points included operating time, conversion rate, reoperation rate, hospital stay, morbidity, quality of life, and costs. The Medical Outcomes Study Short Form 36 and the Gastrointestinal Quality of Life Index were used to evaluate general and bowel-related quality of life.

Results: Groups were comparable for patient characteristics, such as sex, body mass index, preoperative disease duration, and age. There were neither conversions nor intraoperative complications. Median operating time was longer in the total laparoscopic compared with the hand-assisted laparoscopic group (298 vs. 214 minutes; P < 0.001). Morbidity and reoperation rates in the total laparoscopic, hand-assisted laparoscopic, and open groups were comparable (29 vs. 20 vs. 23 percent and 17 vs.10 vs. 13 percent, respectively). Median hospital-stay was 9 days in the total laparoscopic group compared with 10 days in the hand-assisted laparoscopic group and 11 days in the open group (P = not significant). There were no differences in quality of life and total costs.

Conclusions: There were no significant short-term benefits for total laparoscopic compared with hand-assisted laparoscopic restorative proctocolectomy with respect to early morbidity, operating time, quality of life, costs, and hospital stay.

Show MeSH
Related in: MedlinePlus