Hand-Assisted Laparoscopic Versus Open Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis

In Brief 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. The aim of this randomized trial was to evaluate postoperative recovery, in terms of quality of life, after hand-assisted laparoscopic or open proctocolectomy with ileal pouch anal anastomosis in patients with ulcerative colitis and familial adenomatous polyposis. Sixty patients were randomized. Postoperative recovery was comparable after laparoscopic or open proctocolectomy with ileal pouch anal anastomosis.