Purpose: During the course of disease, nearly 30% of ulcerative colitis patients receive surgical therapy. Total proctocolectomy with ileal pouch anal anastomosis is a standard procedure. However, the effectiveness of laparoscopic surgery in ulcerative colitis has not yet been proven. We aimed to evaluate the clinical course of both laparoscopic and open surgeries of a total proctocolectomy with ileal pouch anal anastomosis. Methods: We reviewed charts of 34 patients who underwent a total proctocolectomy with ileal pouch anal anastomosis between April 2005 and April 2014. The laparoscopic group (n=21) and the open group (n=13) were compared retrospectively in accordance with patients’ demographics, clinical features, operative data, and postoperative complications within and after 30 days after the operation. Results: Patient characteristics were not significantly different between the two groups. The laparoscopic group had a longer duration of disease before the operation (42.3±48.5 vs. 105±97.6, p=0.019). The operative results, including operation time and estimated blood loss, were not different in both groups. The postoperative outcomes of laparoscopic surgery were not different from those of open surgery in postoperative complications within and after 30 postoperative days. The rate of reoperation and readmission was not different, and the days until first gas passing and soft diet were not significantly different. Conclusion: Laparoscopic surgery in ulcerative colitis is a feasible and safe procedure. Laparoscopic surgery may provide an alternative approach to open surgery in carefully selected ulcerative colitis patients.

Keywords Ulcerative Colitis, Surgery, Laparoscopy

1. Bennis M, Tiret E. Surgical management of ulcerative colitis. Langenbecks Arch Surg 2012;397:11-17.
   
2. Ellis MC, Diggs BS, Vetto JT, Herzig DO. Trends in the surgical treatment of ulcerative colitis over time: increased mortality and centralization of care. World J Surg 2011;35:671-676.
   
3. Andersson P, Soderholm JD. Surgery in ulcerative colitis: indication and timing. Dig Dis 2009;27:335-340.
   
4. da Luz Moreira A, Lavery IC. Ileorectal anastomosis and proctocolectomy with end ileostomy for ulcerative colitis. Clin Colon Rectal Surg 2010;23:269-273.
   
5. Seifarth C, Ritz JP, Kroesen A, Buhr HJ, Groene J. Effects of minimizing access trauma in laparoscopic colectomy in patients with IBD. Surg Endosc 2015;29:1413-1418.
   
6. Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer Abstracted from: Nelson H, Sargent D, Wieand HS, et al; for the Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050-2059. Cancer Treat Rev 2004;30:707-709.
7. Mak PH, Campbell RC, Irwin MG. The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists. Anaesth Intensive Care 2002;30:633-640.
   
8. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213.
   
9. Baker WN. The results of ileorectal anastomosis at St Mark's Hospital from 1953 to 1968. Gut 1970;11:235-239.
   
10. Parks AG, Nicholls RJ. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J 1978;2:85-88.
    
11. Travis SP, Stange EF, Lemann M, et al. European evidencebased Consensus on the management of ulcerative colitis: Current management. J Crohns Colitis 2008;2:24-62.
    
12. Wu JS, Birnbaum EH, Kodner IJ, Fry RD, Read TE, Fleshman JW. Laparoscopic-assisted ileocolic resections in patients with Crohn's disease: are abscesses, phlegmons, or recurrent disease contraindications? Surgery 1997;122:682-688; discussion 688-689.
    
13. Dunker MS, Bemelman WA, Slors JF, van Duijvendijk P, Gouma DJ. Functional outcome, quality of life, body image, and cosmesis in patients after laparoscopic-assisted and conventional restorative proctocolectomy: a comparative study. Dis Colon Rectum 2001;44:1800-1807.
    
14. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001;44:217-222.
    
15. Santoro E, Carlini M, Carboni F, Feroce A. Laparoscopic total proctocolectomy with ileal J pouch-anal anastomosis. Hepatogastroenterology 1999;46:894-899.
    
16. Heise CP, Kennedy G, Foley EF, Harms BA. Laparoscopic restorative proctocolectomy with ileal S-pouch. Dis Colon Rectum 2008;51:1790-1794.
    
17. Singh P, Bhangu A, Nicholls RJ, Tekkis P. A systematic review and meta-analysis of laparoscopic vs open restorative proctocolectomy. Colorectal Dis 2013;15:e340-351.
    
18. Linden BC, Bairdain S, Zurakowski D, Shamberger RC, Lillehei CW. Comparison of laparoscopic-assisted and open total proctocolectomy and ileal pouch anal anastomosis in children and adolescents. J Pediatr Surg 2013;48:1546-1550.
    
19. Buskens CJ, Sahami S, Tanis PJ, Bemelman WA. The potential benefits and disadvantages of laparoscopic surgery for ulcerative colitis: A review of current evidence. Best Pract Res Clin Gastroenterol 2014;28:19-27.
    
20. Tilney HS, Lovegrove RE, Heriot AG, et al. Comparison of shortterm outcomes of laparoscopic vs open approaches to ileal pouch surgery. Int J Colorectal Dis 2007;22:531-542.
    
21. Selvaggi F, Pellino G, Canonico S, Sciaudone G. Effect of preoperative biologic drugs on complications and function after restorative proctocolectomy with primary ileal pouch formation:systematic review and meta-analysis. Inflamm Bowel Dis 2015;21:7992.
    
22. Nelson R, Liao C, Fichera A, Rubin DT, Pekow J. Rescue therapy with cyclosporine or infliximab is not associated with an increased risk for postoperative complications in patients hospitalized for severe steroid-refractory ulcerative colitis. Inflamm Bowel Dis 2014;20:14-20.
    
23. Gu J, Stocchi L, Remzi F, Kiran RP. Factors associated with postoperative morbidity, reoperation and readmission rates after laparoscopic total abdominal colectomy for ulcerative colitis. Colorectal Dis 2013;15:1123-1129.
    
24. Andersson T, Lunde OC, Johnson E, Moum T, Nesbakken A. Long-term functional outcome and quality of life after restorative proctocolectomy with ileo-anal anastomosis for colitis. Colorectal Dis 2011;13:431-437.